Revista de Métodos de Diagnóstico Médico
Acesso livre
ISSN: 2168-9784
ISSN: 2168-9784
Hiroki Higashihara
Purpose: Computed Tomography (CT) with contrast material is often used for preoperative assessment and planning of embolotherapy in the treatment of Pulmonary Arteriovenous Malformations (PAVMs). However, pulmonary vasculature is well demonstrated in the lung window setting without the need for contrast material; thus, risks of adverse effects of contrast material itself or paradoxical emboli through PAVMs can be avoided. The purpose of this study was to determine the usefulness of non-enhanced 3-Dimentional (3D)-CT angiography for planning of embolotherapy for PAVMs.
Materials and methods: Between February 2004 and October 2011, 20 patients (nine males, 11 females) with 41 PAVMs underwent non-contrast CT using a multi-detector-row CT prior to coil embolotherapy. A high-resolution tailored 3D-CT angiogram was reconstructed on a workstation with partial Maximum Intensity Projection (MIP) in the lung-window to assess the angioarchitecture of the lesions for preoperative planning of embolotherapy. For each lesion, location, number, and diameter of feeding arteries and draining veins were measured. It was determined whether there was any side branch close enough to the sac to anchor the first coil to prevent coil migration. The difference between the diameter of the first coil and the feeding artery was measured. Based on findings, diagnostic pulmonary angiography and coil embolotherapy were performed. The depiction of the side branch of the feeding artery close to sac between preoperative partial MIP 3D-CT images and selective pulmonary angiography was evaluated by using the un-weighted κstatistical analysis.
Results: A total of 49 feeding arteries were embolized. Mean diameter of the feeding arteries and drainage veins were 3.6 mm and 4.6 mm, respectively. Sixteen and eighteen feeding arteries with a side branch to anchor were depicted on CT and angiography, respectively. In the depiction of the side branch of the feeding artery close to sac between preoperative partial MIP images and selective pulmonary angiography, excellent agreement was obtained (κ=0.91). The mean difference between diameter of the first coil and the feeding artery was 1.5 ± 1.47 mm. All 41 lesions could be identified on angiography, and embolization procedures could be executed as planned based on partial MIP images.
Conclusion: Non-enhanced tailored partial MIP 3D-CT in the lung window appears to be a feasible and useful vascular imaging technique for planning coil embolotherapy of PAVMs.