Dilated MMA sign in cDAVF and other arterial feeders on 3D TOF MRA

Abstract

Background Among the varied causes of pulsatile tinnitus, the condition that can cause severe mortality and morbidity is a cranial dural arteriovenous fistula (cDAVF). This study aimed to assess the diagnostic accuracy of the dilated middle meningeal artery on three-dimensional time-of-flight magnetic resonance angiography in cranial dural arteriovenous fistula and to identify other feeders that can aid in the detection of these lesions. Method Magnetic resonance angiography and digital subtraction angiography data of all patients with cranial dural arteriovenous fistula treated in a single tertiary referral center between 2007–2020 were included. The middle meningeal artery and other feeders recorded from digital subtraction angiography were assessed on magnetic resonance angiography. Results The overall agreement between readers in identifying the dilated middle meningeal artery was substantial (κ = 0.878, 95% confidence interval: 0.775–0.982). The dilated middle meningeal artery indicated the presence of a cranial dural arteriovenous fistula with a sensitivity of 79.49% (95% confidence interval: 66.81–92.16), specificity of 100% (95% confidence interval: 100.00–100.00), and negative predictive value of 94.56% (95% confidence interval: 90.89–98.02). An area under the curve of 0.8341 was observed for the ipsilateral middle meningeal artery, with a sensitivity of 92.2% and a specificity of 75.0% at a cut-off of 0.30 mm for identifying a cranial dural arteriovenous fistula. Of 73 other feeders, the occipital, meningohypophyseal trunk, ascending pharyngeal, and posterior meningeal arteries contributed to a large proportion visualized on magnetic resonance angiography (83.6% (41/49)). Conclusion The dilated middle meningeal artery sign is useful for identifying a cranial dural arteriovenous fistula. Dilatation of the occipital and ascending pharyngeal arteries and meningohypophyseal trunk should be assessed to facilitate the detection of a cranial dural arteriovenous fistula, particularly in the transverse-sigmoid and petrous regions.

Intracranial Dural Arteriovenous Fistulas

“…29 30 Dilatation of the middle meningeal and occipital arteries as well as other branches of the external carotid arteries should be assessed for better detection of a cranial DAVF. 31…”

“…29,30 Dilatation of the middle meningeal and occipital arteries as well as other branches of the external carotid arteries should be assessed for better detection of a cranial DAVF. 31 If there is suspicion of DAVF, the patency of the dural sinuses, as well as the cerebral venous drainage patterns, need to be carefully evaluated. [32][33][34] In carotid-cavernous fistulas (CCFs), CT and MRI may demonstrate dilatation of the cavernous sinuses and the superior ophthalmic veins (►Figs.…”

Overview of multimodal MRI of intracranial Dural arteriovenous fistulas

“…Studies have reported that the sensitivity of TOF-MRA in diagnosing DAVF is 79.49% (95% confidence interval CI: 66.81%–92.16%), with a specificity of 100% (95% CI: 100.00%–100.00%). 33 The main diagnostic key is the identification of the feeding artery (middle meningeal artery). Original TOF-MRA images with high spatial resolution have proven to be useful screening tools for DAVFs.…”