Abstract:
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Purpose: To document the growth of small-sized pulmonary arteriovenous malformations (PAVMs) in patients with Hereditary Hemorrhagic Telangiectasia (HHT).
Methods and Materials: 38 consecutive patients with HHT who had undergone a spiral CT examination at the time of initial presentation (T0) and who benefited from a spiral CT follow-up were included in the present study, provided the interval of time between T0 and the most recent follow-up CT scan (T1) was at least 2 years. At T0, the CT findings: (a) consisted of the identification of 156 PAVMs, including 109 small-sized PAVMs (i.e., too small to be re-occluded) and 47 PAVMs with feeding arteries greater than 3mm in diameter (40 simple and 7 complex malformations) for which embolotherapy was indicated; (b) leading to an embolization procedure in 25 patients (Group 1) whereas the remaining 13 patients did not require embolotherapy (Group 2).
Results: The mean interval of time between T0 and T1 was 7.8 years (range: 2.25 — 12). At T1, spiral CT demonstrated: (a) no change in size for 101 (93%) of the 109 initially small-sized PAVMs ; (b) an increase in size for 8 (7%) of the 109 initially small-sized PAVMs, all becoming accessible for therapy owing to the presence of feeding artery(ies) greater than 3mm in diameter; (c) a total of 26 newly developed PAVMs, all of small-size. Comparison of the outcome of small-sized PAVMs between Group 1 and Group 2 patients showed no significant difference between the two groups in the percentage of small-sized PAVMs at T0 which became accessible for treatment at T1 (Group 1: 7%; Group 2: 8.5%; p=0.57) and in the rate of newly developed PAVMs per patient (Group 1: 0.75; Group 2: 0.53; p=0.31). Among Group 1 patients, the efficacy of embolotherapy was not found to influence the incidence of newly developed malformations. None of the patients with small-sized PAVMs, especially among Group 2 patients, suffered from paradoxical embolus between T0 and T1.
Conclusion: The present study demonstrates the slow progression of small-sized PAVMs in patients with HHT, documented in 7% of cases over a 7.8-year period.
Questions about this event email: mremy-jardin@chru-lille.fr
Dumont MD, P,
Natural History of Small-sized Pulmonary Arteriovenous Malformations in Patients with Hereditary Hemorrhagic Telangiectasia: Spiral CT Follow-up over 7.8 Years. Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL.
http://archive.rsna.org/2003/3105895.html
