Susceptibility-Weighted Imaging in Carotido-Cavernous Fistulas

Abstract

This study determined the utility and accuracy of susceptibility-weighted MRI (SWI) for the detection of carotid cavernous fistulas.

We retrospectively compared SWI images in nine patients (Group 1, case group) of DSA-proved carotid cavernous fistula (CCF) and 19 DSA negative cases for CCF as a control group (Group 2). Group 1 was again sub-grouped into direct and indirect types. Using uniform region-of-interest measurements, signal intensity within the superior ophthalmic vein (SOV) and the superior sagittal sinus (SSS) were measured on magnitude images of SWI. The SOV/SSS signal intensity ratio was calculated in each case and the mean values of the two groups were compared.

Eleven SOV/SSS signal intensity ratios in Group 1 (7 unilateral and two bilateral CCF), 38 in Group 2 (both sides in 19 control subjects) were included. Median ± interquartile range of SOV/SSS ratios for Group 1, Group 2, indirect and direct type CCFs were 1.07 ± 0.43, 0.39 ± 0.23, 0.83 ±0.29, 1.4 ±0.38 respectively. Mann-Whitney test between Groups 1 and 2 was statistically significant with P<0.0001. All cases and controls were reliably distinguished with SOV/SSS signal intensity ratio of 0.64 as cut-off. Direct CCF cases had consistently higher ratios than indirect CCF. SWI was highly sensitive for detection and differentiation of both direct and indirect CCF. Only one case of corticovenous reflux was missed by SWI.

SWI is useful for detection of CCF and to differentiate between direct and indirect CCF.

Keywords

carotico-cavernous fistula susceptibility-weighted imaging magnetic resonance imaging

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References

Barnes

Haacke

. Susceptibility-weighted imaging: clinical angiographic applications. Magn Reson Imaging Clin N Am. 2009; 17: 47–61.

Haacke

Mittal

. Susceptibility-weighted imaging: technical aspects and clinical applications, part 1. Am J Neuroradiol. 2009; 30 (1): 19–30.

Barrow

Spector

Braun

. Classification and treatment of spontaneous carotid-cavernous fistulas. J Neurosurg. 62: 248–256.

George

Jolappara

Kesavadas

. Susceptibility-weighted imaging in the evaluation of brain arteriovenous malformations. Neurol India. 2010; 58 (4): 608–614.

Noguchi

Kuwayama

Kubo

. Intracranial dural arteriovenous fistula with retrograde cortical venous drainage: use of susceptibility-weighted imaging in combination with dynamic susceptibility contrast imaging. Am J Neuroradiol. 2010; 31 (10): 1903–1910.

Letourneau-Guillon

Krings

. Simultaneous arteriovenous shunting and venous congestion identification in dural arteriovenous fistulas using susceptibility-weighted imaging: initial experience. Am J Neuroradiol. 2012; 33 (2): 301–307.

Fujima

Kudo

Terae

. Spinal arteriovenous malformation: evaluation of change in venous oxygenation with susceptibility-weighted MR imaging after treatment. Radiology. 2010; 254 (3): 891–899.

Saini

Thomas

Bodhey

. Susceptibility-weighted imaging in cranial dural arteriovenous fistulas. Am J Neuroradiol. 2009; 30 (1): E6.

Tsui

Tsai

Hasso

. Susceptibility-weighted imaging for differential diagnosis of cerebral vascular pathology: a pictorial review. J Neurol Sci. 2009; 287 (1–2): 7–16.

10.

Jagadeesan

Delgado Almandoz

Moran

. Accuracy of susceptibility-weighted imaging for the detection of arteriovenous shunting in vascular malformations of the brain. Stroke. 2011; 42 (1): 87–92.

11.

Miller

. Diagnosis and management of dural carotid-cavernous sinus fistulas. Neurosurg Focus. 2007; 23 (5): E13.

12.

Flaharty

Lieb

Sergott

. Color Doppler imaging. A new noninvasive technique to diagnose and monitor carotid cavernous sinus fistulas. Arch Ophthalmol. 1991; 109 (4): 522–526.

13.

Anderson

Collie

Capewell

. CT angiographic appearances of carotico-cavernous fistula. Clin Radiol. 2001; 56 (6): 514–516.

14.

Ikawa

Uozumi

Kiya

. Diagnosis of carotid-cavernous fistulas with magnetic resonance angiography-demonstrating the draining veins utilizing 3-D time-of-flight and 3-D phase-contrast techniques. Neurosurg Rev. 1996; 19 (1): 7–12.

15.

Chen

Chang

Shy

. CT angiography and MR angiography in the evaluation of carotid cavernous sinus fistula prior to embolization: a comparison of techniques. Am J Neuroradiol. 2005; 26 (9): 2349–2356.

16.

Rucker

Biousse

Newman

. Magnetic resonance angiography source images in carotid cavernous fistulas. Br J Ophthalmol. 2004; 88: 311.

17.

Tanka

Fujita

Hirabuki

. Origin of high signal intensity in the cavernous sinus in MR angiographic source images: correlation between MR and conventional angiography. J Comput Assist Tomogr. 2004; 28: 728–734.

18.

Ouanounou

Tomsick

Heitsman

. Cavernous sinus and inferior petrosal sinus flow signal on three-dimensional time-of-flight MR angiography. Am J Neuroradiol. 1999; 20 (8): 1476–1481.

19.

American College of Radiology. Manual on Contrast Media. Available at: http://www.acr.org/∼/media/ACR/Documents/PDF/QualitySafety/Resources/Contrast%20Manual/FullManual.pdf.

20.

Meckel

Maier

Ruiz

. MR angiography of dural arteriovenous fistulas: diagnosis and follow-up after treatment using a time-resolved 3D contrast-enhanced technique. Am J Neuroradiol. 2007; 28 (5): 877–884.

21.

Paksoy

Genç

. Retrograde flow in the left inferior petrosal sinus and blood steal of the cavernous sinus associated with central vein stenosis: MR angiographic findings. Am J Neuroradiol. 2003; 24 (7): 1364–1368.