Dural arteriovenous fistulas: evaluation with MR imaging.

Abstract

The preangiographic diagnosis of cerebral dural arteriovenous fistula (DAVF) can be difficult. The magnetic resonance (MR) images of 12 patients with angiographically proved DAVF were evaluated to characterize the appearance of these lesions and to identify those patients at increased risk for complications. Patients with DAVF demonstrating venous occlusive disease are at higher risk for complications from the arterialized collateral venous system. This venous occlusive disease is demonstrated best at arteriography. The MR imaging appearance of dilated cortical veins without a parenchymal nidus is suggestive of a DAVF with veno-occlusive disease. Eight of the 12 patients in our series demonstrated this finding at angiography. Complications, including infarction and hemorrhage, were identified at MR imaging in eight patients with MR imaging evidence of veno-occlusive disease. At angiography 42% of these complications were not apparent. In one patient with a DAVF draining into an unobstructed right sigmoid sinus, results of MR study were normal. Although patients with DAVF without veno-occlusive disease may have normal findings at MR imaging, DAVF associated with veno-occlusive disease and dilated pial venous drainage can be documented on MR images. This subset of DAVF patients, many of whom were identified only at MR imaging, is at higher risk for complications due to veno-occlusive disease. These patients are believed to require more urgent therapy. MR imaging is useful in the pretherapeutic planning for patients with DAVF.

CT Angiography as a Screening Tool for Dural Arteriovenous Fistula in Patients with Pulsatile Tinnitus: Feasibility and Test Characteristics

“…21,28,29 Studies have used a variety of techniques and sequences and have shown variable diagnostic performance. De Marco et al 28 presented some of the earliest data, finding MR imaging cortical vein dilation and venous occlusion in 8 of 12 patients with angiographically proved DAVF by using basic spin-and gradient-echo sequences. This description is contrary to the present experience in which the presence of cortical venous dilation was relatively rare, 2/7.…”

Intracranial Dural Arteriovenous Fistula with Retrograde Cortical Venous Drainage: Use of Susceptibility-Weighted Imaging in Combination with Dynamic Susceptibility Contrast Imaging

“…Conventional MR imaging, however, often shows prominent flow voids on the surface of the brain in patients with DAVFs with RCVD. [9][10][11][12] Highintensity lesions in the deep white matter revealed by T2-weighted imaging are secondary to the venous hypertension and venous congestion. The combination of prominent flow voids on the surface of the brain and high intensity lesions in T2-weighted images within the deep white matter is highly suggestive of a DAVF.…”

“…[9][10][11][12] Several investigators have previously reported that MR-DSA is a reliable technique for the screening and monitoring of DAVFs, despite its temporal-and spatialresolution limitations, and that it clearly shows RCVD. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] MR-DSA provides reliable information that can be used to determine the need for patients with DAVFs to undergo additional angiography. 16 A recent study reported that the increased cerebral blood volume in the affected hemisphere of patients with DAVFs with RCVD could be demonstrated with DSC because RCVD causes an increase in cerebral blood volume as a result of the dilation of cerebral veins.…”

Evaluation of Dural Arteriovenous Fistulas with 4D Contrast-Enhanced MR Angiography at 3T

“…[5][6][7][8][9][10] However, the clinical use of these techniques remains limited because of the lack of hemodynamic information and the possibility of misdiagnosis. [7][8][9][10][11][12] Time-resolved contrast-enhanced MR angiography (MRA) at 1.5T has been applied to the diagnosis of intracranial DAVF.…”