Nucl Med Mol Imaging.  2006 Dec;40(6):316-321.

Diagnosis and Post-Therapeutic Evaluation of Arteriovenous Malformations in Extremities Using Transarterial Lung Perfusion Scintigraphy

• Chung HW
• Choi JY
• Kim YW
• Kim DI
• Do YS
• Lee EJ
• Lee SJ
• Cho YS
• Hyun SH
• Lee KH
• Kim BT

Abstract

PURPOSE: Differential diagnosis between arteriovenous (AVMs) and non-arteriovenous malformations (nAVMs) is important in patients with congenital vascular malformations, because AVMs can cause hemodynamic alteration and require immediate treatment. We investigated whether transarterial lung perfusion scintigraphy (TLPS) was useful for the diagnosis and post-therapeutic evaluation of AVMs in extremities.
MATERIALS AND METHODS
Fifty-seven patients (M:F=26:31, 21+/-13 yr, 9 upper and 48 lower extremities) suspected of congenital vascular malformations in extremities underwent TLPS using 99mTc-MAA before embolization/sclerotherapy. Dose-corrected shunt fraction (SF) was calculated from time-activity curve of the lung. Final diagnosis of AVMs was determined by angiography. In patients with AVMs, follow-up TLPS was done for post-therapeutic evaluation.
RESULTS
Sixteen patients (8 upper and 8 lower extremities) had AVMs, while the remaining 41 had nAVMs (1 upper and 40 lower extremities). The mean SF of AVMs on TLPS was significantly higher than that of nAVMs (66.4+/-25.8% vs. 2.8+/-4.3%, p=0.003). The sensitivity, specificity, and accuracy of TLPS (cut-off of SF = 20.0%) in diagnosis of AVMs before treatment were 93.8% (15/16), 100% (41/41) and 98.2% (56/57), respectively. The follow-up TLPS and angiography for post-therapeutic evaluation showed concordant results in 13 of 16 patients (81.3%) with AVMs. The mean SF of TLPS was significantly decreased after embolization/sclerotherapy (69.5+/-24.0% vs. 41.0+/-34.7%, p=0.01).
CONCLUSION
TLPS provides hemodynamic information of AVMs in extremities semiquantitatively. Furthermore, the results of TLPS showed a high concordance rate with angiographic findings. Therefore, TLPS is useful for the diagnosis and post-therapeutic evaluation of AVMs in extremities.

Keyword

arteriovenous malformation; transarterial lung perfusion scintigraphy; 99mTc-MAA; angiography

MeSH Terms

Angiography
Arteriovenous Malformations*
Diagnosis*
Diagnosis, Differential
Extremities*
Follow-Up Studies
Hemodynamics
Humans
Lung*
Perfusion Imaging*
Perfusion*
Sensitivity and Specificity
Vascular Malformations