The Role of Time-Resolved MRA for Post-treatment Assessment of Pulmonary Arteriovenous Malformations: A Pictorial Essay

Kawai, Tatsuya; Shimohira, Masashi; Hashizume, Takumi; Muto, Masahiro; Suzuki, Kazushi; Kurosaka, Kenichiro; Shibamoto, Yuta

doi:10.1007/s00270-016-1325-2

Cited by 7 publications

(9 citation statements)

References 10 publications

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“…Because the population of patients with VAAs are relatively old and chronic kidney disease is relatively common, sometimes it might be worrisome to administer gadolinium chelate [ 14 , 15 ]. Although a former study [ 13 ] reported that a motion artefact was one of the factors affecting image quality, it was acceptable in all the cases in our study. Perhaps it was because the reported cases had relatively small pulmonary arteriovenous malformations located in the area close to the apex of the left ventricle of the heart, where the motion of the lesion tends to be vigorous even in a good breath-holding state.…”

Section: Discussioncontrasting

confidence: 53%

“…Kawai et al . [ 12 , 13 ] reported that the advantages of TR-MRA compared to contrast-enhanced and/or unenhanced CT were: 1) less susceptibility to metallic artefacts from platinum coils, 2) detectability of dynamic blood flow at a high temporal resolution, and 3) no radiation exposure. In the two cases in which recanalisation was confirmed on DSA in our study, intra-aneurysmal blood flow was clearly shown on TR-MRA with a minimal signal void, whereas it was difficult to assess contrast enhancement on CT, especially for one lesion for which aneurysmal packing was performed because of severe metallic artefacts.…”

Section: Discussionmentioning

confidence: 99%

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Time-resolved magnetic resonance angiography as a follow-up method for visceral artery aneurysm treated with coil-embolisation

et al. 2018

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PurposeThe purpose of this study is to assess the feasibility and usefulness of time-resolved magnetic resonance angiography (TR-MRA) for follow-up of visceral artery aneurysms (VAAs) after embolotherapy.Material and methodsTwenty-one VAAs (11 splenic, six renal, three internal iliac, and one superior pancreaticoduodenal artery aneurysms) in 18 patients (median age, 64 years; range, 36-88 years) previously treated by embolisation with platinum coils, were evaluated. The mean size of the aneurysm was 10.5 cm3 (range, 0.3-132 cm3). Among them, 19 lesions were treated by aneurysmal packing with or without distal-to-proximal embolisation. For the remaining two lesions, distal-to-proximal embolization alone was performed. The mean observation period after embolotherapy was 35 weeks (range, 4-216). All patients underwent TR-MRA following an intravenous bolus injection of gadolinium chelate. Recanalisation was diagnosed when any portion of the aneurysmal sac was enhanced in the arterial phase.ResultsOn TR-MRA, two lesions were diagnosed as recanalised. They were confirmed by transcatheter arteriography and re-treated by embolotherapy. For the remaining 19 lesions, there were no findings of recanalisation on TR-MRA.ConclusionsTR-MRA appears to be a feasible method for follow-up examination of VAAs treated by embolotherapy.

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Section: Discussioncontrasting

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Time-resolved magnetic resonance angiography as a follow-up method for visceral artery aneurysm treated with coil-embolisation

et al. 2018

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“…Occlusion was diagnosed based on shrinkage after embolization, and the recanalization rate was reported to be up to 19% in some studies [ 4 , 19 , 32 – 34 ]. However, it was recently reported that TR-MRA is superior to CT for diagnosing recanalization of a PAVM, due to its high sensitivity in detecting flow and very few artifacts from platinum coils [ 11 – 14 ]. On the other hand, using TR-MRA, the recanalization rates are reportedly much higher than the previously reported; the rates at 3, 6, 12, and 24 months were 8, 27, 36, and 49%, respectively, for 12 untreated PAVMs, and 50, 50, 92, and 100%, respectively, for 12 recanalized PAVMs [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…The median number of follow-up examinations was 3 (range 1–7), and the median periods of the first, second, third, fourth, fifth, sixth, and seventh follow-up examinations were 2, 6, 12, 18, 29, 32, and 41 months after coil embolization. On TR-MRA, recanalization was defined as simultaneous enhancement of the feeding artery and draining vein or enhancement of the venous sac in the pulmonary arterial phase (before visualization of the normal pulmonary vein) [ 11 – 14 ]. In patients with multiple PAVMs, not all of the PAVMs could be embolized in a single session; thus, those that were previously embolized were evaluated by using PAG during subsequent embolization sessions, instead of TR-MRA.…”

Section: Methodsmentioning

confidence: 99%

Usefulness of Hydrogel-Coated Coils in Embolization of Pulmonary Arteriovenous Malformations

Shimohira

Kawai

Hashizume

et al. 2018

Cardiovasc Intervent Radiol

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PurposeTo evaluate the usefulness of hydrogel-coated coils for preventing recanalization after coil embolization of pulmonary arteriovenous malformations (PAVMs).Materials and MethodsThirty-seven consecutive patients with 57 untreated PAVMs underwent coil embolization with hydrogel-coated coils between January 2013 and Jun 2017. The mean age was 49 years (range 9–83 years), and there were seven male patients and 30 female patients. The median size of the feeding artery was 3.7 mm (range 1.5–6.1 mm), and the median size of the venous sac was 9.3 mm (range 2.6–36.6 mm). For all PAVM, embolization was attempted using 0.018-in. hydrogel-coated coils with or without other coils (0.0135–0.018-in. bare platinum coils and fibered platinum coils). Technical success rate, recanalization rate, and complications were evaluated. Technical success was defined as completion of embolization using hydrogel-coated coils. Recanalization was evaluated with time-resolved magnetic resonance angiography and/or pulmonary angiography.ResultsIn 56 of 57 PAVMs, embolization was successfully performed with hydrogel-coated coils. Therefore, the technical success rate was 98% (56/57). The number of PAVMs at risk was 56, 42, 18, and 12 at 0, 12, 24, and 36 months, respectively. There was no recanalization with a mean follow-up period of 19 months (range 2–47 months) in 56 PAVMs embolized with hydrogel-coated coils. There were no major complications. As a minor complication, local pain was observed in 8 of 43 sessions (19%) after embolization.ConclusionsHydrogel-coated coils may be useful for preventing recanalization after the embolization of PAVMs.

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“…This technique demonstrates the flow dynamics of a PAVM without radiation exposure. However, previous TR-MRA studies mainly focused on one PAVM per single contrast injection [ 17 ]. Their studies showed limited efficacy in applying this modality to multiple PAVMs due to limited acquisition volume or failure to match CT [ 14 17 ].…”

Section: Introductionmentioning

confidence: 99%

Feasibility of Single-Shot Whole Thoracic Time-Resolved MR Angiography to Evaluate Patients with Multiple Pulmonary Arteriovenous Malformations

et al. 2022

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Objective To evaluate the feasibility of single-shot whole thoracic time-resolved MR angiography (TR-MRA) to identify the feeding arteries of pulmonary arteriovenous malformations (PAVMs) and reperfusion of the lesion after embolization in patients with multiple PAVMs. Materials and Methods Nine patients (8 females and 1 male; age range, 23–65 years) with a total of 62 PAVMs who underwent percutaneous embolization for multiple PAVMs and were subsequently followed up using TR-MRA and CT obtained within 6 months from each other were retrospectively reviewed. All imaging analyses were performed by two independent readers blinded to clinical information. The visibility of the feeding arteries on maximum intensity projection (MIP) reconstruction and multiplanar reconstruction (MPR) TR-MRA images was evaluated by comparing them to CT as a reference. The accuracy of TR-MRA for diagnosing reperfusion of the PAVM after embolization was assessed in a subgroup with angiographic confirmation. The reliability between the readers in interpreting the TR-MRA results was analyzed using kappa (κ) statistics. Results Feeding arteries were visible on the original MIP images of TR-MRA in 82.3% (51/62) and 85.5% (53/62) of readers 1 and 2, respectively. Using the MPR, the rates increased to 93.5% (58/62) and 95.2% (59/62), respectively (κ = 0.760 and 0.792, respectively). Factors for invisibility were the course of feeding arteries in the anteroposterior plane, proximity to large enhancing vessels, adjacency to the chest wall, pulsation of the heart, and small feeding arteries. Thirty-seven PAVMs in five patients had angiographic confirmation of reperfusion status after embolization (32 occlusions and 5 reperfusions). TR-MRA showed 100% (5/5) sensitivity and 100% (32/32, including three cases in which the feeding arteries were not visible on TR-MRA) specificity for both readers. Conclusion Single-shot whole thoracic TR-MRA with MPR showed good visibility of the feeding arteries of PAVMs and high accuracy in diagnosing reperfusion after embolization. Single-shot whole thoracic TR-MRA may be a feasible method for the follow-up of patients with multiple PAVMs.

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The Role of Time-Resolved MRA for Post-treatment Assessment of Pulmonary Arteriovenous Malformations: A Pictorial Essay

Cited by 7 publications

References 10 publications

Time-resolved magnetic resonance angiography as a follow-up method for visceral artery aneurysm treated with coil-embolisation

Time-resolved magnetic resonance angiography as a follow-up method for visceral artery aneurysm treated with coil-embolisation

Usefulness of Hydrogel-Coated Coils in Embolization of Pulmonary Arteriovenous Malformations

Feasibility of Single-Shot Whole Thoracic Time-Resolved MR Angiography to Evaluate Patients with Multiple Pulmonary Arteriovenous Malformations

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