Diagnosis of pulmonary arteriovenous malformations by colour Doppler ultrasound and amplitude ultrasound angiography
Departments of Internal Medicine and Laboratory
Medicine, National Taiwan University Hospital, Taipei, Taiwan, Republic
of China
Correspondence to: Dr P-C Yang, Department of Internal Medicine, National Taiwan University Hospital, No. 7 Chung-Shan South Road, Taipei, Taiwan.
Received 23 June 1997; Returned to authors 25 September 1997; Revised version received 24 November 1997; Accepted for publication 7 January 1998
BACKGROUND
The clinical value of colour Doppler
ultrasound and amplitude ultrasound angiography in the diagnosis and
follow up of pulmonary arteriovenous malformations (PAVM) was investigated.
METHODSSix consecutive patients suspected by
clinical appearance and abnormal chest radiographic findings of having
PAVM were included in the study. Ultrasonography was performed first by
real time grey scale imaging then by colour Doppler imaging and
amplitude ultrasound angiography in a random order. All were later
proved by angiography to have PAVM.
RESULTSThe ultrasound study was successfully
performed in all six patients. A total of eight lesions was detected.
The real time grey scale image of PAVM revealed well defined hypoechoic
subpleural nodules with strong posterior acoustic enhancement. Colour
Doppler ultrasound of PAVM showed turbulent flow, manifest as an area of intense colour with high and mixed velocities (reticulated or
mosaic-like pattern). Anatomical continuity was demonstrated in some
PAVM. Amplitude ultrasound angiography can delineate a tangled vascular
structure with a clear vessel wall and anatomical continuity as well as
conventional angiography. Spectral wave analysis showed a relatively
low impedance flow presenting with high peak systolic velocity (mean
44.4 cm/s) and relatively high diastolic velocity (mean 19.3 cm/s). The
mean pulsatility index (PI) and resistive index (RI) were 1.80 and
0.49, respectively. In two patients who received embolotherapy the
colour Doppler ultrasound scan obtained after the procedure showed that
the previous focal areas of colour flow signals disappeared or
diminished in size. This was compatible with the decrease in, or
absence of, blood flow demonstrated by angiography after embolotherapy.
CONCLUSIONSCombined colour Doppler ultrasound and
amplitude ultrasound angiography are useful non-invasive techniques for
diagnosing PAVM and provide an alternative approach to angiography in
evaluating the efficacy of embolotherapy.
© 1998 by Thorax
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