Schneider Guenther, Uder Michael, Koehler Michael, Kirchin Miles A, Massmann Alexander, Buecker Arno, Geisthoff Urban
Department of Diagnostic and Interventional Radiology, University Hospital of Saarland, 66421 Homburg/Saar, Germany.
AJR Am J Roentgenol. 2008 Apr;190(4):892-901. doi: 10.2214/AJR.07.2966.
The purpose of our study was to evaluate contrast-enhanced MR angiography (CE-MRA) as a screening procedure for the detection of pulmonary arteriovenous malformations (AVMs) in patients with hereditary hemorrhagic telangiectasia (HTT).
Two hundred three consecutive subjects (patients with diagnosed HHT or first-degree relatives; 87 males, 116 females; 6-83 years old) underwent pulmonary CE-MRA with 0.1 mmol/kg of gadobenate dimeglumine. The presence of pulmonary AVM was scored as 0 (none present), 1 (definitely present), or 2 (uncertain) and was evaluated by patient sex and pulmonary AVM size (< 5, 5-10, 11-15, 16-20, > 20 mm). Patients scored as 1 or 2 with at least one pulmonary AVM of > or = 5 mm underwent conventional pulmonary angiography for possible embolization. Pulmonary AVM detection on CE-MRA and pulmonary angiography was compared using paired Student's t tests.
The presence of pulmonary AVM was considered definite in 56 of 203 (27.6%) patients and uncertain in one of 203 patients on CE-MRA. Of 156 pulmonary AVMs detected on CE-MRA, 124 (49 in 27 males, 75 in 30 females) were detected on first screening CE-MRA and 32 on follow-up CE-MRA. Pulmonary AVMs on CE-MRA were solitary in 25 patients, multiple in 31 patients, and predominantly small (< 5 mm, n = 32; 5-10 mm, n = 45). Significantly (p < 0.0001) fewer pulmonary AVMs were detected on pulmonary angiography (76/96 [79.2%] evaluable pulmonary AVMs in 40 patients before first pulmonary angiography; 92/119 [77.3%] pulmonary AVMs overall). Three-dimensional maximum-intensity-projection reconstructions permitted improved pulmonary AVM visualization and embolization planning of complex pulmonary AVMs.
CE-MRA is suitable for screening patients with HHT. It permits accurate detection and staging of pulmonary AVMs, appropriate differentiation of lesions requiring embolization and accurate orientation, and visualization and planning of embolization therapy.
我们研究的目的是评估对比增强磁共振血管造影（CE-MRA）作为一种筛查方法，用于检测遗传性出血性毛细血管扩张症（HTT）患者的肺动静脉畸形（AVM）。
203名连续受试者（确诊为HHT的患者或一级亲属；87名男性，116名女性；年龄6 - 83岁）接受了0.1 mmol/kg钆贝葡胺的肺部CE-MRA检查。肺AVM的存在情况分为0（无）、1（肯定存在）或2（不确定），并按患者性别和肺AVM大小（<5、5 - 10、11 - 15、16 - 20、>20 mm）进行评估。在CE-MRA检查中被评为1或2且至少有一个肺AVM≥5 mm的患者接受传统肺血管造影以进行可能的栓塞治疗。使用配对t检验比较CE-MRA和肺血管造影对肺AVM的检测情况。
在203名患者中，56名（27.6%）患者的肺AVM存在情况在CE-MRA检查中被认为是肯定的，1名患者的情况不确定。在CE-MRA检查中检测到的156个肺AVM中，124个（27名男性中的49个，30名女性中的75个）在首次筛查CE-MRA时被检测到，32个在随访CE-MRA时被检测到。CE-MRA检查中的肺AVM在25名患者中为单发，31名患者中为多发，且大多较小（<5 mm，n = 32；5 - 10 mm，n = 45）。在肺血管造影中检测到的肺AVM明显较少（首次肺血管造影前40名患者中有76/96[79.2%]个可评估的肺AVM；总体上为92/119[77.3%]个肺AVM）。三维最大强度投影重建有助于改善肺AVM的可视化以及对复杂肺AVM的栓塞治疗规划。
CE-MRA适用于筛查HHT患者。它能够准确检测和分期肺AVM，对需要栓塞治疗的病变进行适当鉴别并准确定位，以及可视化和规划栓塞治疗。
