Objectives Dural arteriovenous fistula (DAVFs) in the transverse sinus (TS)/sigmoid sinus (SS) and cavernous sinus (CS) are observed frequently in the clinic. This study aimed to detect DAVFs with ultrasound and compare carotid ultrasound findings between these conditions. Methods We retrospectively reviewed 26 patients with either a TS/SS DAVF or a CS DAVF who were admitted to our hospital for evaluation of DAVFs from 2014 to 2018. The shunt site decision was made by neuroendovascular experts, whereas carotid ultrasound examinations were performed by ultrasound specialists. The flow velocity of the ipsilateral external carotid artery was reviewed in all 26 patients, whereas that of the occipital artery (OA) was examined in 20 patients. Blood flow velocities were compared between the TS/SS DAVF and CS DAVF groups. Results The study included 18 patients with a TS/SS DAVF (11 women and 7 men; mean age ± SD, 65.3 ± 18.6 years) and 8 patients with a CS DAVF (7 women and 1 man; mean age, 70.4 ± 9.3 years). Evaluations of feeder arteries on cerebral angiography showed that all patients had dural branches from the internal carotid and middle meningeal arteries as feeders of CS DAVFs, whereas the OA was the major feeder source of all TS/SS DAVF cases. The end‐diastolic velocity (EDV) of the external carotid artery was significantly higher in patients with a TS/SS DAVF compared with those with a CS DAVF (P = .004). The EDV of the OA was significantly elevated in TS/SS DAVF cases compared with CS DAVF cases (P < .001). Conclusions Duplex ultrasound parameters are significantly different between patients with TS/SS and CS DAVFs. An increased EDV of the OA can predict the presence of a TS/SS DAVF.

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We report two cases of direct-type carotid cavernous fistula (CCF) which was diagnosed on carotid ultrasonography (CUS). Case1: A 69-year-old woman. She had abrupt onset of diplopia and tinnitus. Head computed tomography and magnetic resonance imaging (MRI) indicated she had right CCF. CUS indicated an increase in end-diastolic velocity (EDV) of the right internal carotid artery (ICA). Pulsatility index (PI) and resistance index (RI) decreased to 0.63 and 0.45, respectively. CCA end-diastolic ratio rose, and this showed the significant laterality of flow between the right and left ICAs. Case2: An 88-year-old woman who complained visual impairment had right exophthalmos, conjunctival injection and bruit around right orbit. Head MRI demonstrated the dilatation of right superior ophthalmic vein, which reflected the existence of right CCF. On the CUS study, peak systolic velocity (PSV) and EDV of the right ICA were significantly elevated, and PI and RI were decreased to 0.63 and 0.45, respectively. CCA end-diastolic ratio was also significantly elevated. After treatment of the CCF, these values returned toward normal. Since vascular resistance of the affected side is low in CCF patients, CUS easily determined the abnormality as well as the change after treatment. Thus, CUS is useful for both screening and determining the treatment effect of direct-type CCF.Keywords: carotid ultrasonography (CUS)， carotid cavernous fistula (CCF)， pulsatility index (PI)， resistance index (RI)

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