Pulmonary arteriovenous malformations (PAVMs) are often associated with hereditary haemorrhagic telangiectasia (HHT). The quantification of right-to-left shunts in patients with PAVMs is important in diagnosis and follow up. Traditionally, this shunt is measured by the 100% oxygen method, in which the value for the arteriovenous difference in oxygen content, Cao2-Co2 (where Cao2 is the oxygen content of arterial blood and C
o2 is the oxygen content of mixed venous blood) is estimated. Alternative methods consist of measurement of the systemic or renal uptake of 99mTc-labelled macroaggregates of albumin (MAA), which are trapped in pulmonary capillaries, but pass through PAVMs. We first measured Cao2-C
o2 in 12 HHT patients before and after embolization of PAVMs. We obtained a mean value of 4.4ml/100ml, instead of the usual 5ml/100ml. Subsequently, we measured right-to-left shunt in 21 HHT patients using the 100% oxygen method and with two different methods involving 99mTc. We used the kidney-lung method (K/L method), in which it is assumed that the right kidney receives 10% of the cardiac output, and we also used a method with two tracers (HSA/MAA method): (1) 99mTc-labelled human serum albumin (HSA) (which passes through pulmonary capillaries) to measure the fraction of the cardiac output perfusing the kidneys, and (2) MAA to measure the shunt fraction. In 35 shunt measurements we evaluated this new technique and the K/L method, by comparing the results with those from the 100% oxygen method. There was poor agreement between the 100% oxygen method and the K/L method, with 95% limits of agreement for the shunt fraction of -15.2% to +15.2%. There was moderate agreement between the 100% oxygen method and the HSA/MAA method, with limits of agreement of -8.3% to +7.7%. We conclude that the different methods cannot replace each other, because the limits of agreement are too wide for clinical use.
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January 03 2002
Quantification of right-to-left shunt with 99mTc-labelled albumin macroaggregates and 100% oxygen in patients with hereditary haemorrhagic telangiectasia
Johannes J. MAGER;
Johannes J. MAGER
*Department of Pulmonology, St. Antonius Hospital, 3430 EM Nieuwegein, The Netherlands
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Pieter ZANEN;
Pieter ZANEN
*Department of Pulmonology, St. Antonius Hospital, 3430 EM Nieuwegein, The Netherlands
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Fred VERZIJLBERGEN;
Fred VERZIJLBERGEN
†Department of Nuclear Medicine, St. Antonius Hospital, 3430 EM Nieuwegein, The Netherlands
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Cornelius J.J. WESTERMANN;
*Department of Pulmonology, St. Antonius Hospital, 3430 EM Nieuwegein, The Netherlands
Correspondence: Dr C. J. J. Westermann (e-mail [email protected]).
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Tjeerd HAITJEMA;
Tjeerd HAITJEMA
‡Department of Pulmonology, Medical Centre Alkmaar, 1800 AM Alkmaar, The Netherlands
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Gerard VAN HERK;
Gerard VAN HERK
†Department of Nuclear Medicine, St. Antonius Hospital, 3430 EM Nieuwegein, The Netherlands
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Jan-Willem J. LAMMERS
Jan-Willem J. LAMMERS
§Department of Pulmonology, University Hospital Utrecht, 3508 GA Utrecht, The Netherlands
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Publisher: Portland Press Ltd
Received:
February 12 2001
Revision Received:
July 02 2001
Accepted:
September 05 2001
Online ISSN: 1470-8736
Print ISSN: 0143-5221
The Biochemical Society and the Medical Research Society © 2002
2002
Clin Sci (Lond) (2002) 102 (2): 127–134.
Article history
Received:
February 12 2001
Revision Received:
July 02 2001
Accepted:
September 05 2001
Citation
Johannes J. MAGER, Pieter ZANEN, Fred VERZIJLBERGEN, Cornelius J.J. WESTERMANN, Tjeerd HAITJEMA, Gerard VAN HERK, Jan-Willem J. LAMMERS; Quantification of right-to-left shunt with 99mTc-labelled albumin macroaggregates and 100% oxygen in patients with hereditary haemorrhagic telangiectasia. Clin Sci (Lond) 1 February 2002; 102 (2): 127–134. doi: https://doi.org/10.1042/cs1020127
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