Scintigraphic Analysis of Hemodynamics in a Patient with a Single Large Pulmonary Arteriovenous Fistula

Suga, Kazuyoshi; Kuramitsu, T; Yoshimizu, T; Nakanishi, Takashi; Yamada, Norimasa; Utsmi, Hiromoto

doi:10.1097/00003072-199202000-00009

Cited by 10 publications

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“…11 Lung and total-body imaging with Technetium99m-macroaggregated albumin (Tc-99m MAA) has been used to elucidate pulmonary perfusion and/or systemic circulation, and to estimate the magnitude of intracardiac RLS in cyanotic children with complex congenital heart disease. [1][2][3][4][5][6][7][8][9][10] In the presence of RLS, MAA particles reach the systemic circulation to lodge in the capillary beds of the end extrapulmonary organs, 1,a-6,8,10 and distribution of these radioparticles therefore supposedly reflects normal or abnormal perfusion in the depicted organs. In this paper, we described unusual or unexpected abnormalities in cerebral perfusion demonstrated by Tc-99m MAA total-body scanning in two children with complex con- Fig.…”

Section: Introductionmentioning

confidence: 99%

Abnormal brain perfusion demonstrated by Tc-99m MAA total-body scan in two children with complex congenital heart disease

et al. 1998

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This paper describes abnormal brain perfusion unexpectedly demonstrated by Tc-99m MAA total-body imaging in two children with intracardiac right-to-left shunt (RLS) associated with complex congenital heart disease. One child was a 12-year-old girl with asplenia cardiac syndrome and multiple cerebral infarctions caused by thromboembolism in the internal carotid artery, and the other child was a 6-month-old boy who developed focal cerebral infarction following shunt operation. In both children, the total-body imaging depicted the brain due to RLS, where radioactivity decreased unilaterally in the cerebral hemisphere. In the first patient, radioactivity also decreased in the contralateral cerebellum, suggesting the crossed cerebellar diaschisis phenomenon. These abnormalities in brain perfusion were confirmed by Tc-99m HMPAO brain SPECT. Careful review of the distribution of the radiotracer in the depicted brain on Tc-99m MAA total-body imaging may provide important information regarding brain perfusion in some patients with a high risk of stroke complication associated with RLS.

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Section: Introductionmentioning

confidence: 99%

Abnormal brain perfusion demonstrated by Tc-99m MAA total-body scan in two children with complex congenital heart disease

et al. 1998

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“…The defects at normallyappearing lungs may be due to a steal of blood flow by AVC. This ''steal phenomenon'' in normal lungs adjacent to shunt lesions has been documented in patients with arteriovenous fistulas showing right-to-left shunt [25].…”

Section: Discussionmentioning

confidence: 82%

“…Determination of the type and location of shunt lesions with fusion images will help to decide whether the lesion is amenable to embolization therapy or not [1,8,24,25]. Although lung transplantation is currently the sole therapeutic option available for the diffuse type of AVC, accurate localization of this lesion will contribute to regional infusion treatment with vasoactive agents [2,5].…”

Section: Discussionmentioning

confidence: 99%

Findings of hepatopulmonary syndrome on breath-hold perfusion SPECT-CT fusion images

Suga¹,

Kawakami²,

Iwanaga

et al. 2009

Ann Nucl Med

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Pulmonary perfusion SPECT-CT fusion images were used to characterize CT manifestations of intrapulmonary arteriovenous communications (AVC) causing right-to-left shunt and hepatopulmonary syndrome (HPS). After scanning the whole body and obtaining multiple view images of the lung, deep-inspiratory breath-hold (DIBrH) SPECT was obtained in 2 patients with HPS, which was automatically and three-dimensionally co-registered with DIBrH CT. In both patients, the whole body scan depicted systemic organs and confirmed the existence of right-to-left shunt. DIBrH SPECT-CT fusion images showed that perfusion defects were predominantly located at subpleural reticulo-nodular opacities and/or dilated vessels in the lung base. Subpleural reticulo-nodular opacities and/or dilated vessels in the lung base appear to be characteristic CT manifestation of intrapulmonary AVC in HPS.

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“…These relatively large perfusion defects may be partly explained by the steal phenomenon resulting from the rapid arteriovenous shunt blood flow. 22 These segmental and/or subsegmental perfusion defects on Tc-99m MAA scans do not specifically indicate intrapulmonary shunting, and must be differentiated from those of pulmonary embolism in the cases without a discrete abnormality on chest radiograph and ventilation scan. 18,20 A total-body Tc-99m MAA image presenting abnormal tracer uptake in various systemic organs appears to be a useful tool for suspecting the presence of right-to-left shunting, as there was a case report in which pulmonary arteriography failed to diagnose an intrapulmonary arteriovenous communication, but it was correctly indicated by this total-body image.…”

Section: Discussionmentioning

confidence: 98%

Reversed Intrapulmonary Right-to-Left Shunt After Banding of the Patent Ductus Venosus

Suga

Ogasawara²,

Matsunaga³

et al. 2003

Clinical Nuclear Medicine

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Diffuse pulmonary microvascular arteriovenous communication developed in an 8-year-old girl with a patent ductus venosus. Tc-99m macroaggregated albumin (MAA) pulmonary perfusion scintigraphy with total-body imaging demonstrated multiple lung perfusion deficits and abnormal tracer uptake in systemic organs with hepatic radioactivity greater than the kidneys, suggesting the presence of right-to-left shunt and abnormal hepatic hemodynamics. I-123 iodoamphetamine transrectal portal scintigraphy revealed a large portosystemic venous shunt. The follow-up Tc-99m MAA perfusion scans after banding of the patent ductus venosus revealed partial improvement of the perfusion deficits and right-to-left shunt, indicating the possible reversibility of this pulmonary shunt complication.

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Scintigraphic Analysis of Hemodynamics in a Patient with a Single Large Pulmonary Arteriovenous Fistula

Cited by 10 publications

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Abnormal brain perfusion demonstrated by Tc-99m MAA total-body scan in two children with complex congenital heart disease

Abnormal brain perfusion demonstrated by Tc-99m MAA total-body scan in two children with complex congenital heart disease

Findings of hepatopulmonary syndrome on breath-hold perfusion SPECT-CT fusion images

Reversed Intrapulmonary Right-to-Left Shunt After Banding of the Patent Ductus Venosus

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