Preliminary Diagnosis: Arterial venous malformations (AVMS)

I. What imaging technique is first-line for this diagnosis?

Gray-scale and color Doppler ultrasounds

II. Describe the advantages and disadvantages of this technique for diagnosis of AVMs.

Advantages

  • Easily demonstrates abnormal blood vessels and abnormal blood flow

  • Well-tolerated examination that is relatively inexpensive

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Disadvantages

  • May be difficult to image and dependent on operator experience

  • Screening examination that does not provide detailed anatomic information

III. What are the contraindications for the first-line imaging technique?

No absolute contraindications exist.

IV. What alternative imaging techniques are available?

  • CT

  • MR

  • Catheter angiography

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of AVMs.

CT
Advantages

  • Can demonstrate an abnormal tangle of vessels with enlarged draining veins

  • Provides detailed evaluation of surrounding viscera

  • Multiplanar and 3D reformatted images are useful for treatment planning.

Disadvantages

  • Radiation exposure

  • Iodinated contrast may result in contrast-induced nephropathy.

MRI
Advantages

  • Accurately depicts the extent of the malformation and provides multiplanar images for treatment planning

  • Avoids radiation exposure

Disadvantages

  • Relatively expensive examination

  • Long-examination times may not be tolerated by claustrophobic patients

Catheter angiography
Advantages

  • Readily demonstrates a large tangle of dilated vessels

  • Endovascular treatment may be peformed at the time of diagnosis

Disadvantages

  • Radiation exposure

  • Iodinated contrast may result in contrast-induced nephropathy

  • Risk of access site and catheter-induced injury

VI. What are the contraindications for the alternative imaging techniques?

CT

  • Renal failure due to the risk of contrast induced nephropathy

  • Pregnancy

  • Contrast allergy may be a relative contraindication

MRI

  • Renal failure due to the risk of nephrogenic systemic fibrosis with gadolinium administration

  • Certain implanted metallic devices, such as aneurysm clips and pacemakers, may not be MRI compatible.

  • First trimester pregnancy may be a relative contraindication.

Catheter angiography

  • Renal failure due to the risk of contrast induced nephropathy may be a relative contraindication (CO2 may be used as an alternative in certain cases).

  • Pregnancy

  • Contrast allergy may be a relative contraindication.

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