Maruno Miyuki, Kiyosue Hiro, Hongo Norio, Matsumoto Shunro, Mori Hiromu
Department of Radiology, Oita University Faculty of Medicine, 1-1 Idaigaoka Hasama-machi, Yufu-shi, Oita, 879-5593, Japan.
Cardiovasc Intervent Radiol. 2018 Dec;41(12):1849-1856. doi: 10.1007/s00270-018-2063-4. Epub 2018 Aug 22.
Reperfusion via pulmonary-to-pulmonary arterial anastomoses is known as one type of recurrence of pulmonary arteriovenous malformations (PAVMs) after embolization. It is important to occlude the fistulous portion beyond the origin of the last normal branch from feeding artery of PAVMs to prevent recurrence. In this study, we evaluate the origin of the last normal branch by CT as well as its visibility on pulmonary arteriography (PAG).
We reviewed forty patients with 77 PAVMs who underwent coil embolization between October 2007 and December 2017. All patients underwent MDCT before embolization. Axial and MPR CT lung images were reviewed with special interests in the origin of the last normal branch from feeding artery of PAVMs. The origin was classified into three portions, including sac, junction (portion just proximal to the sac) and proximal feeder (more than 5 mm proximal to the sac). We also evaluated whether PAG can depict the normal branches detected by MDCT.
MDCT showed that the last normal branch originated from sac in 30 PAVMs (39.0%), junction in 39 (50.6%), and proximal feeder in 8 (10.4%).On selective PAG, the last normal branch could be visualized in 30 PAVMs (39.0%), although it could not be visualized due to high-flow shunt in the other 47 PAVMs.
Selective PAG frequently fails to demonstrate the last normal branch from feeding artery of PAVMs, which often originates from the sac. Pretherapeutic evaluation of CT images of the last normal branch is important to prevent reperfusion of PAVMs.
Level 3, local non-random sample.
通过肺-肺动脉吻合进行再灌注是肺动静脉畸形（PAVM）栓塞术后复发的一种类型。闭塞PAVM供血动脉最后一个正常分支起始点以外的瘘管部分对于预防复发很重要。在本研究中，我们通过CT评估最后一个正常分支的起始点及其在肺动脉造影（PAG）上的显影情况。
我们回顾了2007年10月至2017年12月期间接受弹簧圈栓塞治疗的40例患者的77处PAVM。所有患者在栓塞术前均接受了MDCT检查。对轴向和MPR CT肺图像进行了回顾，特别关注PAVM供血动脉最后一个正常分支的起始点。该起始点分为三个部分，包括囊袋、交界处（囊袋近端紧邻部分）和近端供血支（囊袋近端超过5mm处）。我们还评估了PAG是否能显示MDCT检测到的正常分支。
MDCT显示，77处PAVM中，最后一个正常分支起源于囊袋的有30处（39.0%），起源于交界处的有39处（50.6%），起源于近端供血支的有8处（10.4%）。在选择性PAG上，77处PAVM中有30处（39.0%）可显示最后一个正常分支，另外47处PAVM由于高流量分流而无法显示。
选择性PAG经常无法显示PAVM供血动脉的最后一个正常分支，该分支常起源于囊袋。术前对最后一个正常分支的CT图像进行评估对于预防PAVM再灌注很重要。
3级，局部非随机样本。
