BACKGROUND High-resolution chest CT (HRCT) is recommended after PAVM embolotherapy to assess for PAVM persistence and untreated PAVM growth. Graded transthoracic contrast echocardiography (TTCE) predicts need for embolotherapy in PAVM screening. This study sought to determine whether post-embolotherapy graded TTCE can similarly predict need for repeat embolotherapy. METHODS Thirty-two patients (8M:24F, mean age 51.1 ± 12.6 years) with prior PAVM embolotherapy and follow-up HRCT were prospectively enrolled. Patients underwent graded TTCE using a validated 3-point quantitative grading scale. TTCE grade and HRCT findings were compared. RESULTS Median time between most recent HRCT and TTCE was 7 days (interquartile range 0-272 days). Thirty patients (94%) had no PAVMs requiring repeat embolotherapy on HRCT. Two patients (6%) had PAVMs requiring repeat embolotherapy (FA ≥ 3 mm), 1 with untreated PAVM growth and 1 with treated PAVM persistence. TTCE was positive in 88% (n=28) of patients. All patients (n=4, 12%) with negative TTCE had no visible PAVMs on HRCT. Nine patients (32%) had grade 1 shunt, ten (35%) had grade 2 shunt, and nine (32%) had grade 3 shunt. No patients with grade 1 shunt had PAVMs amenable to repeat embolotherapy on HRCT. All patients (n=2) with PAVMs requiring repeat embolotherapy (FA ≥ 3 mm) had grade 3 shunt. TTCE grade was significantly associated PAVM feeding artery diameter (P < 0.001). CONCLUSIONS Post-embolotherapy graded TTCE can predict need for repeat embolotherapy on HRCT. Patients with negative TTCE and grade 1 shunt may not require HRCT follow-up and can potentially be followed with serial graded TTCE.

中文翻译：

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栓塞治疗后肺动静脉畸形随访：高分辨率胸部 CT 前分级经胸对比超声心动图的作用

背景 推荐在 PAVM 栓塞治疗后进行高分辨率胸部 CT (HRCT) 以评估 PAVM 的持续性和未经治疗的 PAVM 生长。分级经胸对比超声心动图 (TTCE) 可预测 PAVM 筛查中栓塞治疗的必要性。本研究旨在确定栓塞治疗后分级的 TTCE 是否可以类似地预测重复栓塞治疗的需要。方法 前瞻性招募了 32 名既往接受过 PAVM 栓塞治疗和随访 HRCT 的患者（8M:24F，平均年龄 51.1 ± 12.6 岁）。患者使用经过验证的 3 点定量分级量表进行分级 TTCE。比较了 TTCE 等级和 HRCT 结果。结果 最近一次 HRCT 和 TTCE 之间的中位时间为 7 天（四分位距为 0-272 天）。30 名患者 (94%) 在 HRCT 上没有需要重复栓塞治疗的 PAVM。2 名患者 (6%) 的 PAVM 需要重复栓塞治疗（FA ≥ 3 mm），1 名未治疗的 PAVM 生长，1 名治疗后的 PAVM 持续存在。TTCE 在 88% (n=28) 的患者中呈阳性。所有 TTCE 阴性的患者 (n=4, 12%) 在 HRCT 上都没有可见的 PAVM。9 名患者 (32%) 有 1 级分流，10 名 (35%) 有 2 级分流，9 名 (32%) 有 3 级分流。没有 1 级分流患者的 PAVM 适合在 HRCT 上重复栓塞治疗。所有需要重复栓塞治疗（FA ≥ 3 mm）的 PAVM 患者（n=2）都有 3 级分流。TTCE 等级与 PAVM 供血动脉直径显着相关（P < 0.001）。结论 栓塞治疗后分级的 TTCE 可以预测 HRCT 是否需要重复栓塞治疗。TTCE 阴性和 1 级分流的患者可能不需要 HRCT 随访，并且有可能进行系列分级 TTCE 随访。