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Intracranial Dural Arteriovenous Fistulas: Evaluation with Combined 3D Time-of-Flight MR Angiography and MR Digital Subtraction Angiography

¹ Department of Radiology, Toyama Medical and Pharmaceutical University, 2630 Sugitani, Toyama, 930-0194, Japan.
² Department of Radiology, Neuroradiology Section, University of Pennsylvania Medical Center, Philadelphia, PA 19104.
³ Department of Neurosurgery, Toyama Medical and Pharmaceutical University, Toyama, 930-0194, Japan.

View larger version (138K): [in a new window]   Fig. 1A. —68-year-old woman with dural arteriovenous fistula of right transverse and sigmoid sinuses. Figures A–C were obtained before embolization, and D–F were obtained after embolization. Source image of 3D time-of-flight (TOF) MR angiography (TR/TE, 40/6.5; flip angle, 20°) clearly shows findings of multiple high-intensity nodular structures adjacent to sinus wall (small arrows) and multiple high-intensity spots around these structures—findings suggestive of feeding arteries—and shows high-intensity areas in venous sinus (large arrow) at right transverse and sigmoid sinuses.

View larger version (137K): [in a new window]   Fig. 1D. —68-year-old woman with dural arteriovenous fistula of right transverse and sigmoid sinuses. Figures A–C were obtained before embolization, and D–F were obtained after embolization. Source image of 3D TOF MR angiography shows small multiple high-intensity structures adjacent to sinus wall findings (arrow) at wall of right sigmoid sinus.

View larger version (134K): [in a new window]   Fig. 2A. —29-year-old woman with spontaneous regression of right transverse and sigmoid dural arteriovenous fistula without therapy. Source image of first 3D time-of-flight (TOF) MR angiography shows findings of multiple high-intensity curvilinear or nodular structures adjacent to sinus wall (small arrows) and high-intensity areas in venous sinus (large arrow) at right transverse and sigmoid sinuses. Dural arteriovenous fistula of transverse and sigmoid sinuses was confirmed by digital subtraction angiography (not shown).

View larger version (102K): [in a new window]   Fig. 3A. —45-year-old woman with meningioma at tuberculum sellae without dural arteriovenous fistula. Initial image of MR digital subtraction angiography (including only left hemisphere) shows normal arterial structures without venous contamination.

View larger version (102K): [in a new window]   Fig. 1B. —68-year-old woman with dural arteriovenous fistula of right transverse and sigmoid sinuses. Figures A–C were obtained before embolization, and D–F were obtained after embolization. Initial image of MR digital subtraction angiography (4.6/1.8; flip angle, 25°) (including only right hemisphere) shows early filling of venous sinus finding (arrow) at right transverse and sigmoid sinuses.

View larger version (111K): [in a new window]   Fig. 4A. —78-year-old man with dural arteriovenous fistula of bilateral transverse and sigmoid sinuses and superior sagittal sinus with retrograde cortical venous drainage and venous sinus occlusion. Initial image of MR digital subtraction angiography (including only right hemisphere) shows extensive early filling of venous sinus (large arrows) with reflux into Labbé's vein (small arrows).

View larger version (117K): [in a new window]   Fig. 1E. —68-year-old woman with dural arteriovenous fistula of right transverse and sigmoid sinuses. Figures A–C were obtained before embolization, and D–F were obtained after embolization. Initial image of MR digital subtraction angiography does not show early filling of venous sinus, which is suggestive of dural arteriovenous fistula.

View larger version (115K): [in a new window]   Fig. 4B. —78-year-old man with dural arteriovenous fistula of bilateral transverse and sigmoid sinuses and superior sagittal sinus with retrograde cortical venous drainage and venous sinus occlusion. Second image of MR digital subtraction angiography shows congestion of cortical venous drainage and occlusion (arrow) of right transverse and sigmoid sinuses.

View larger version (124K): [in a new window]   Fig. 4C. —78-year-old man with dural arteriovenous fistula of bilateral transverse and sigmoid sinuses and superior sagittal sinus with retrograde cortical venous drainage and venous sinus occlusion. Third (C) and fourth (D) images of MR digital subtraction angiography clearly show sequential changes of congestion of cortical venous drainage and venous sinus occlusion (arrow).

View larger version (132K): [in a new window]   Fig. 4D. —78-year-old man with dural arteriovenous fistula of bilateral transverse and sigmoid sinuses and superior sagittal sinus with retrograde cortical venous drainage and venous sinus occlusion. Third (C) and fourth (D) images of MR digital subtraction angiography clearly show sequential changes of congestion of cortical venous drainage and venous sinus occlusion (arrow).

View larger version (124K): [in a new window]   Fig. 2B. —29-year-old woman with spontaneous regression of right transverse and sigmoid dural arteriovenous fistula without therapy. After patient was observed for approximately 6 months, source image of follow-up 3D TOF MR angiography shows disappearance of both multiple high-intensity structures adjacent to sinus wall and high-intensity areas in venous sinus, which are suggestive of dural arteriovenous fistula.

View larger version (151K): [in a new window]   Fig. 2C. —29-year-old woman with spontaneous regression of right transverse and sigmoid dural arteriovenous fistula without therapy. Digital subtraction angiogram confirms spontaneous regression of dural arteriovenous fistula without venous sinus occlusion.

View larger version (130K): [in a new window]   Fig. 3B. —45-year-old woman with meningioma at tuberculum sellae without dural arteriovenous fistula. Second image of MR digital subtraction angiography already shows normal venous structures. Note meningioma (arrow) at tuberculum sella.

View larger version (144K): [in a new window]   Fig. 3C. —45-year-old woman with meningioma at tuberculum sellae without dural arteriovenous fistula. Third image of MR digital subtraction angiography clearly shows normal venous structures and meningioma (arrow).

View larger version (166K): [in a new window]   Fig. 1C. —68-year-old woman with dural arteriovenous fistula of right transverse and sigmoid sinuses. Figures A–C were obtained before embolization, and D–F were obtained after embolization. Digital subtraction angiogram of lateral view of right common carotid injection shows filling of dural arteriovenous fistula of transverse and sigmoid sinuses via numerous fine branches of occipital artery.

View larger version (157K): [in a new window]   Fig. 1F. — 68-year-old woman with dural arteriovenous fistula of right transverse and sigmoid sinuses. Figures A–C were obtained before embolization, and D–F were obtained after embolization. Digital subtraction angiogram shows small residual dural arteriovenous fistula (arrow) at sigmoid sinus.

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