Lee Seon-Kyu, Willinsky Robert A, Montanera Walter, terBrugge Karel G
Department of Medical Imaging, Division of Neuro-imaging, University of Toronto, Toronto Western Hospital, Ontario, Canada.
AJNR Am J Neuroradiol. 2003 Sep;24(8):1602-6.
Retrograde leptomeningeal venous drainage (RLVD) in a dural arteriovenous fistula (DAVF) is associated with intracerebral hemorrhage, nonhemorrhagic neurologic deficit, or death, and recognizing the presence of this drainage is important. We investigated the MR findings of DAVFs draining into cerebellar cortical veins and compared these findings with those of conventional angiography.
The MR and angiographic findings of six patients (five men, one woman; mean age, 73.4 years) with DAVF with RLVD into cerebellar cortical veins were reviewed retrospectively. Signal intensity characteristics, contrast material enhancement, topography of the lesion, and presence of signal voids were evaluated on MR images. Site of the shunt, feeding arteries, and draining veins were evaluated on angiograms.
In all patients, MR images showed high signal intensity on T2-weighted images and peripheral enhancement on gadolinium-enhanced T1-weighted images at the inferior aspect of the cerebellar hemisphere. A combination of posterior meningeal and occipital arteries was the most frequent blood supply (83%) for these DAVFs. In all six patients, the inferior hemispheric vein was the primary draining vein.
The characteristic MR findings of DAVF draining into cerebellar cortical veins represent venous congestive encephalopathy in the territory of the involved cortical vein.
硬脑膜动静脉瘘（DAVF）中的逆行软脑膜静脉引流（RLVD）与脑出血、非出血性神经功能缺损或死亡相关，识别这种引流的存在很重要。我们研究了引流至小脑皮质静脉的DAVF的磁共振成像（MR）表现，并将这些表现与传统血管造影的表现进行比较。
回顾性分析6例（5例男性，1例女性；平均年龄73.4岁）存在引流至小脑皮质静脉的RLVD的DAVF患者的MR和血管造影表现。在MR图像上评估信号强度特征、对比剂增强、病变的形态以及有无信号缺失。在血管造影上评估分流部位、供血动脉和引流静脉。
所有患者的MR图像均显示小脑半球下部在T2加权图像上呈高信号强度，在钆增强T1加权图像上呈周边强化。脑膜后动脉和枕动脉联合供血是这些DAVF最常见的供血方式（83%）。所有6例患者中，半球下静脉是主要的引流静脉。
引流至小脑皮质静脉的DAVF的特征性MR表现代表受累皮质静脉区域的静脉性充血性脑病。
