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Pulmonary Arteriovenous Malformation Treated with Embolotherapy: Systemic Collateral Supply at Multidetector CT Angiography after 2–20-year Follow-up¹

¹ From the Department of Thoracic Imaging, Calmette Hospital, University Center of Lille, Boulevard Jules Leclerc, 59037, Lille Cedex, France (P.Y.B., P.D., N.B., J.R., M.R.); Department of Medical Statistics, University of Lille, Lille, France (A.D.); and Department of Radiology, Cardiologic Hospital, Pessac, France (F.L.). Received September 10, 2004; revision requested November 18; revision received February 24, 2006; accepted March 22; final version accepted April 18. Address correspondence to M.R. (e-mail: mremy-jardin{at}chru-lille.fr).

Purpose: To retrospectively evaluate frequency of systemic arterial collateral supply to treated pulmonary arteriovenous malformations (PAVMs) in long-term follow-up with multi–detector row helical computed tomography (CT).

Materials and Methods: Institutional review board approval was obtained, with waiver of informed consent. Thirty-two patients (19 male, 13 female; mean age, 43 years) underwent follow-up multi–detector row helical CT angiography of the chest (collimation, 16 x 0.75 mm) 2 or more years after embolotherapy of PAVMs. The study group had a history of successful embolotherapy of 53 PAVMs and a mean of 9 years of follow-up (range, 2–20 years). A search for abnormal systemic arteries was based on analysis of thin-collimated contiguous transverse CT scans and two- and three-dimensional images including maximum intensity projections and volume-rendered images. Statistical comparison was performed with the Fisher exact test (categoric variables) and Wilcoxon rank sum test (continuous variables).

Results: At CT, 13 patients (group 1) had abnormally enlarged systemic arteries and 19 patients (group 2) had no abnormal arteries. In group 1, 32 abnormally enlarged arteries were seen—five bronchial and 27 nonbronchial arteries (14 inferior phrenic, six musculophrenic, five internal mammary, two intercostal). The degree of enlargement was moderate for 26 arteries and marked for six. There were no significant differences between groups for (a) clinical characteristics of patients, including history of surgery before or after embolotherapy (P = .7); (b) anatomic structures of treated PAVMs; and (c) embolization procedures and their effectiveness. The number of patients with features suggestive of lung infarction in the days or months after embolotherapy was significantly higher in group 1 (P = .04). On CT angiograms, the number of patients with features suggestive of sequelae of lung infarction was significantly higher in group 1 (P = .02). There were no symptomatic differences attributable to systemic collateral supply between groups; in particular, there was no hemoptysis in group 1.

Conclusion: Abnormally enlarged systemic arteries were present in 13 of 32 patients, in whom there was a significantly higher frequency of clinical and/or radiographic features suggestive of lung infarction after embolotherapy.

© RSNA, 2006