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  • Title: Scintigraphic evaluation of small pulmonary right-to-left shunt and therapeutic effect in pulmonary arteriovenous malformation.
    Author: Sugiyama M, Sakahara H, Igarashi T, Takahashi M.
    Journal: Clin Nucl Med; 2001 Sep; 26(9):757-60. PubMed ID: 11507292.
    Abstract:
    PURPOSE: Right-to-left shunts of pulmonary arteriovenous malformation (PAVM) can be detected and measured by pulmonary perfusion scans using Tc-99m MAA. In PAVM with a relatively small right-to-left shunt, however, measurement of the shunt ratio may not be reliable. This study re-evaluated pulmonary perfusion scans for a small right-to-left shunt of PAVM. METHODS: Tc-99m MAA lung scans were performed in five patients with proved PAVM before and after percutaneous transcatheter embolization. The right-to-left shunt ratio was calculated and extrapulmonary uptake was assessed on total-body images. RESULTS: Lung perfusion scans obtained before embolization revealed brain uptake in four patients, and the shunt ratio ranged from 4.4% to 22.9%. In two patients with a small single PAVM, the shunt ratio was less than 15% before treatment and did not change significantly after successful embolotherapy. The brain uptake, which had been clearly visible before therapy, disappeared after embolization. Renal uptake was seen on pre- and post-therapy scans. CONCLUSIONS: Changes in brain activity visible on Tc-99m MAA scans might be a more reliable sign than a decreased shunt ratio or a change in renal uptake when evaluating embolization therapy in patients with PAVM who have a small right-to-left shunt.
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