Carotid ultrasound for pulmonary arteriovenous malformation screening

Anita Yanna-Schulze 1 , Günther Schneider 2 , 3 , Alexander Maßmann 3 , Stefan Gräber 4 , and Urban W. Geisthoff 5
  • 1 Department of Cardiology, Städtisches Krankenhaus Pirmasens gGmbH, Pettenkoferstr. 22, 66955 Pirmasens, Germany
  • 2 Medical Faculty of the Saarland University, 66421 Homburg/Saar, Germany
  • 3 Department of Diagnostic and Interventional Radiology, Saarland University Hospital, 66421 Homburg/Saar, Germany
  • 4 Department of Medical Biometry, Epidemiology and Medical Informatics, Saarland University Hospital, 66421 Homburg/ Saar, Germany
  • 5 Department of Otorhinolaryngology, Essen University Hospital, 45147 Essen, Germany


Objective: In patients with hereditary hemorrhagic telangiectasia (HHT), pulmonary arteriovenous malformations (PAVMs) can cause serious neurological complications. Our aim was to evaluate the potential of contrast-enhanced Doppler ultrasound (CE-US) of the common carotid artery as a screening test for detection of PAVMs. Methods: A total of 124 consecutive patients with HHT or a positive family history underwent screening for PAVMs with CE-US and thoracic contrast-enhanced magnetic resonance angiography (CE-MRA). CE-US was performed after receiving (D)-galactose microparticulate, and CE-MRA with gadobenate dimeglumine. Twenty-five patients with confirmed PAVMs were referred to conventional pulmonary catheter angiography (PA). Findings on CE-US and CE-MRA were evaluated using contingency tables and McNemar’s test. Results: Using CE-MRA as the reference test, CE-US had a sensitivity of 100%, a specificity of 87%, and a negative predictive value of 100%. In 25 patients who underwent PA, PAVMs that had been diagnosed on CE-US and CE-MRA were confirmed. Of the PAVMs detected by CE-MRA, 24% were not identified on PA. Conclusion: CE-US is a simple, minimally invasive screening method that can easily be performed in different settings. CE-US can predict PAVMs with high probability of success. CE-US may be a simple alternative to transthoracic echocardiography in the assessment of PAVMs in certain HHT-patients.

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