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Location of embolization affects patency after coil embolization for pulmonary arteriovenous malformations: importance of time-resolved magnetic resonance angiography for diagnosis of patency

  • Interventional
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Abstract

Objectives

This study aimed to assess the diagnostic accuracy of computed tomography (CT) and time-resolved magnetic resonance angiography (TR-MRA) for patency after coil embolization of pulmonary arteriovenous malformations (PAVMs) and identify factors affecting patency.

Methods

Data from the records of 205 patients with 378 untreated PAVMs were retrospectively analyzed. Differences in proportional reduction of the sac or draining vein on CT between occluded and patent PAVMs were examined, and receiver operating characteristic analysis was performed to assess the accuracy of CT using digital subtraction angiography (DSA) as the definitive diagnostic modality. The accuracy of TR-MRA was also assessed in comparison to DSA. Potential factors affecting patency, including sex, age, number of PAVMs, location of PAVMs, type of PAVM, and location of embolization, were evaluated.

Results

The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of CT were 82%, 81%, 77%, 85%, and 82%, respectively, when the reduction rate threshold was set to 55%, which led to the highest diagnostic accuracy. The sensitivity, specificity, PPV, NPV, and accuracy of TR-MRA were 89%, 95%, 89%, 95%, and 93%, respectively. On both univariable and multivariable analyses, embolization of the distal position to the last normal branch of the pulmonary artery was a factor that significantly affected the prevention of patency.

Conclusions

TR-MRA appears to be an appropriate method for follow-up examinations due to its high accuracy for the diagnosis of patency after coil embolization of PAVMs. The location of embolization is a factor affecting patency.

Key Points

• Diagnosis of patency after coil embolization for pulmonary arteriovenous malformations (PAVMs) is important because a patent PAVM can lead to neurologic complications.

• The diagnostic accuracies of CT with a cutoff value of 55% and TR-MRA were 82% and 93%, respectively.

• The positioning of the coils relative to the sac and the last normal branch of the artery was significant for preventing PAVM patency.

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Abbreviations

AVP:

AMPLATZER Vascular Plug

CT:

Computed tomography

DSA:

Digital subtraction angiography

HHT:

Hereditary hemorrhagic telangiectasia

MVP:

MVP Micro Vascular Plug

NPV:

Negative predictive value

PAVM:

Pulmonary arteriovenous malformation

PPV:

Positive predictive value

ROC:

Receiver operating characteristic

TR-MRA:

Time-resolved magnetic resonance angiography

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Acknowledgments

We would like to express our deep appreciation to Masaki Komiyama, Tatsuya Kawai and the members of HHT JAPAN.

Funding

This study has received funding by the Clinical Research Group of the Japanese Society for Transcatheter Hepatic Arterial Embolization.

Author information

Author notes

  1. Keigo Osuga

    Present address: Department of Diagnostic Radiology, Osaka Medical College, Takatsuki, Japan

  2. Tetsuro Nakazawa

    Present address: Department of Diagnostic Imaging, Osaka General Medical Center, Osaka, Japan

Authors and Affiliations

  1. Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, 467-8601, Japan

    Masashi Shimohira

  2. Department of Radiology, Oita University, Yufu, Japan

    Hiro Kiyosue & Miyuki Maruno

  3. Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Japan

    Keigo Osuga & Tetsuro Nakazawa

  4. Department of Radiology, Okayama University Medical School, Okayama, Japan

    Hideo Gobara & Yusuke Matsui

  5. Department of Radiology, Teikyo University School of Medicine, Itabashi, Tokyo, Japan

    Hiroshi Kondo

  6. Department of Radiology, Jichi Medical University, Saitama Medical Center, Saitama, Japan

    Kohei Hamamoto

  7. Department of Neuro-Intervention, Osaka City General Hospital, Osaka, Japan

    Tomoya Ishiguro

  8. Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan

    Koji Sugimoto

  9. Department of Radiology, Kurume University School of Medicine, Kurume, Japan

    Masamichi Koganemaru

  10. Department of Radiology, Aichi Medical University, Nagakute, Japan

    Akira Kitagawa

  11. Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan

    Koichiro Yamakado

Authors
  1. Masashi Shimohira
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  2. Hiro Kiyosue
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  4. Hideo Gobara
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  7. Yusuke Matsui
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  8. Kohei Hamamoto
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  9. Tomoya Ishiguro
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Corresponding author

Correspondence to Masashi Shimohira.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Masashi Shimohira.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

The requirement to obtain informed consent was waived because of the retrospective design.

Ethical approval

Institutional Review Board approval was obtained in each institution.

Approval number was as follows:

Nagoya City University Graduate School of Medical60160070

Oita University1061

Osaka University Graduate School of Medicine16362

Okayama University Medical Schoolken1611-009

Saitama Medical Center, Jichi Medical UniversityS16-090

Osaka City General Hospital1708047

Kobe University Graduate School of Medicine180012

Kurume University School of Medicine16194

Aichi Medical University2016-H272

Hyogo College of Medicine2522

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in following articles.

Makimoto S, Hiraki T, Gobara H, et al (2014) Association between reperfusion and shrinkage percentage of the aneurysmal sac after embolization of pulmonary arteriovenous malformation: evaluation based on contrast-enhanced thin-section CT images. Jpn J Radiol 32:266–273

Osuga K, Kishimoto K, Tanaka K, et al (2014) Initial experience with use of hydrogel microcoils in embolization of pulmonary arteriovenous malformations. Springerplus 17;3:609

Hamamoto K, Matsuura K, Chiba E, et al (2016) Feasibility of non-contrast-enhanced MR angiography using the time-SLIP technique for the assessment of pulmonary arteriovenous malformation. Magn Reson Med Sci 15:253–265

Maruno M, Kiyosue H, Hongo N, et al (2018) Where is the origin of the last normal branch from feeding artery of pulmonary arteriovenous malformations? Cardiovasc Intervent Radiol 41:1849–1856

Shimohira M, Kawai T, Hashizume T, et al (2015) Reperfusion rates of pulmonary arteriovenous malformations after coil embolization: evaluation with time-resolved MR angiography or pulmonary angiography. J Vasc Interv Radiol 26:856–864.e1

Shimohira M, Kawai T, Hashizume T, Muto M, Kitase M, Shibamoto Y (2018) Usefulness of hydrogel-coated coils in embolization of pulmonary arteriovenous malformations. Cardiovasc Intervent Radiol 41:848–855

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• diagnostic or prognostic study

• multicenter study

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Shimohira, M., Kiyosue, H., Osuga, K. et al. Location of embolization affects patency after coil embolization for pulmonary arteriovenous malformations: importance of time-resolved magnetic resonance angiography for diagnosis of patency. Eur Radiol 31, 5409–5420 (2021). https://doi.org/10.1007/s00330-020-07669-w

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  • DOI: https://doi.org/10.1007/s00330-020-07669-w

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