Role of Noncontrast Cone-Beam Computed Tomography in Pulmonary Arteriovenous Malformation Embolization

Objective: To evaluate the role of noncontrast cone-beam computed tomography (CBCT) in pulmonary arteriovenous malformation (PAVM) embolization. Materials and Methods: This retrospective single-center study included 63 patients (mean age, 51.3 ± 12.1 years; 8 males, 55 females) who underwent PAVM embolization between January 2018 and June 2024. Patients were categorized into a CBCT-assisted group (n = 13) and a digital subtraction angiography (DSA)-only group (n = 50). The use of CBCT was determined selectively at the discretion of the performing interventional radiologists. Patient demographics, PAVM characteristics, radiation exposure, fluoroscopy time, procedure time, and the number of DSA acquisitions were compared between the two groups. Technical and clinical success were evaluated. Results: CBCT guidance significantly reduced the number of DSA acquisitions (2.4 ± 1.0 vs. 4.9 ± 2.6, p = 0.001), procedure time (54.6 ± 24.3 min vs. 75.1 ± 34.5 min, p = 0.021), and fluoroscopy time (14.9 ± 12.0 min vs. 25.5 ± 18.2 min, p = 0.017) compared with DSA-only group. Dose-area product (87.7 ± 111.4 Gy·cm2 vs. 86.0 ± 58.7 Gy·cm2; p = 0.959) and cumulative air-kerma (387.2 ± 464.2 mGy vs. 354.5 ± 305.7 mGy; p = 0.811) did not differ significantly between the groups. Technical success was achieved in all cases (100%). Clinical success rates were 98% in the DSA-only group and 100% in the CBCT group, with no significant difference (p = 1.000). No procedure-related complications were observed. Conclusions: Noncontrast CBCT may improve procedural efficiency in PAVM embolization by reducing DSA acquisitions and procedure time without significantly increasing radiation dose. This technique provides valuable anatomical guidance, particularly in complex scenarios such as obscured or multiple lesions.