Guenther Karl Schneider MD, PhD, Presenter: Nothing to Disclose

Alexander Massmann MD, Abstract Co-Author: Nothing to Disclose

Marcus Katoh MD, PhD, Abstract Co-Author: Nothing to Disclose

Urban W. Geisthoff MD, Abstract Co-Author: Consultant, Spiggle & Theiss, Overrath, Germany Consultant, Olympus Corporation

Peter Fries MD, Abstract Co-Author: Nothing to Disclose

Arno Buecker MD, Abstract Co-Author: Nothing to Disclose

To evaluate the potential of CE MRA for detection of reperfused pulmonary arteriovenous malformations (PAVMs) after coil embolization in patients with Hereditary Hemorrhagic Telangiectasia (HHT).

Between February 1999 and March 2009 256 patients with diagnosed HHT or first degree relatives, underwent MRI screening for cerebral, pulmonary and visceral manifestations of HHT. The database was retrospectively analyzed regarding patients suffering from reperfused PAVMs after coil embolization of PAVM. The diagnosis of reperfused PAVM was made based on CE MRA (gadobenate dimeglumine, 0.1 mmol/kg bodyweight) and confirmed by catheter angiography.

During the observation period 164 PAVMs in 56 patients were embolized using platinum coils. In each case complete occlusion of the feeding vessels was achieved. Follow-up CE MRA studies revealed reperfusion of 6/164 embolized PAVMs in 5/56 patients. Additionally, CE MRA revealed 6 reperfused PAVMs in 3 patients who had undergone embolization in another hospital. All patients showing reperfused PAVMs underwent catheter angiography and reembolization of the reperfused PAVMs. No additional reperfused PAVMs were detected on catheter angiography. Reperfusion was due to biodegradation of coils (2 reperfused PAVMs in 1 patient) caused by corrosion of applied tungsten filaments, insufficiently tight packing of the embolization coils (8 PAVMs in 5 patients) and opening of collateral feeding vessels (2 PAVMs in 2 patients).

Reperfusion of PAVMs may occur after a longer time interval. Consequently, regular follow-up studies are mandatory. At many centers CT imaging is used for this purpose, despite the fact that image quality and the ability to accurately detect PAVM reperfusion may be affected by metal artifacts arising from the embolization material. Our results show that CE MRA is a useful alternative for follow-up of treated PAVMs in cases in which platinum coils were used for embolization.

Follow-up of PAVMs after coil embolization is mandatory to detect reperfusion. CE-MRA is well suited for this purpose, possibly supplanting radiation exposure by CT.

Schneider, G, Massmann, A, Katoh, M, Geisthoff, U, Fries, P, Buecker, A, Detection of Reperfused Pulmonary Arteriovenous Malformations with Contrast-enhanced Magnetic Resonance Angiography (CE MRA) in Patients with HHT (Hereditary Hemorrhagic Telangiectasia).  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8014756.html