Akiba H, Tamakawa M, Hyodoh H, Hyodoh K, Yama N, Nonaka T, Minamida Y, Hashimoto M, Hareyama M
Department of Radiology, Sapporo Medical University, School of Medicine, Sapporo, Japan.
AJNR Am J Neuroradiol. 2008 Oct;29(9):1652-7. doi: 10.3174/ajnr.A1187. Epub 2008 Jun 26.
Flow voids within the cavernous sinuses and/or certain venous drainage on spin-echo MR imaging and time-of-flight (TOF) flow enhancement on MR angiography (MRA) have indicated high-velocity shunt flow and have been used for screening patients with dural arteriovenous fistulas (DAVFs) of the cavernous sinuses. In this investigation, the capabilities of 3D dynamic MRA as a flow-independent approach and those of conventional MR imaging techniques were compared with selective angiography for the diagnosis of DAVFs of the cavernous sinuses.
This retrospective study involved 18 patients with angiographically proved DAVFs of the cavernous sinuses and 12 control subjects. Sixteen partially overlapping sequential MR images were acquired on contrast-enhanced 3D dynamic MRA between the petrosal bone and the orbital roof. Two experienced observers blinded to the clinical data and results of angiography independently graded 3D dynamic MRA, fast spin-echo T2-weighted imaging (FSE T2WI), and TOF MRA.
The average area under the receiver operating characteristic curve values and interobserver kappa scores for the diagnosis of DAVFs on 3D dynamic MRA, FSE T2WI, and TOF MRA were 0.99, 0.89, and 0.95; and 0.92, 0.71, and 0.73, respectively. Those for the diagnosis of anterior, posterior, and retrograde cortical venous drainage on 3D dynamic MRA were 0.72, 0.95, and 0.81; and 0.56, 0.50, and 0.49, respectively.
In this small series, screening 3D dynamic MRA directly demonstrates DAVFs of the cavernous sinuses and has improved diagnostic capability.
海绵窦内的血流空洞和/或自旋回波磁共振成像上的特定静脉引流以及磁共振血管造影（MRA）上的时间飞跃（TOF）血流增强提示高速分流，并已用于筛查海绵窦硬脑膜动静脉瘘（DAVF）患者。在本研究中，将三维动态MRA作为一种不依赖血流的方法的能力以及传统磁共振成像技术的能力与选择性血管造影用于诊断海绵窦DAVF的能力进行了比较。
这项回顾性研究纳入了18例经血管造影证实为海绵窦DAVF的患者和12名对照受试者。在对比增强三维动态MRA上，在岩骨和眶顶之间采集了16幅部分重叠的连续磁共振图像。两名对临床资料和血管造影结果不知情的经验丰富的观察者对三维动态MRA、快速自旋回波T2加权成像（FSE T2WI）和TOF MRA进行独立分级。
三维动态MRA、FSE T2WI和TOF MRA诊断DAVF的平均受试者操作特征曲线下面积值和观察者间kappa评分分别为0.99、0.89和0.95；以及0.92、0.71和0.73。三维动态MRA诊断前、后和逆行皮质静脉引流的平均受试者操作特征曲线下面积值和观察者间kappa评分分别为0.72、0.95和0.81；以及0.56、0.50和0.49。
在这个小样本系列中，筛查三维动态MRA能直接显示海绵窦DAVF，且具有更高的诊断能力。
