Department of Neurosurgery, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
Neurosurg Rev. 2010 Apr;33(2):217-22; discussion 222-3. doi: 10.1007/s10143-010-0246-9. Epub 2010 Feb 25.
Digital subtraction angiography (DSA) is the preferred method for confirming dural arteriovenous fistulas (DAVFs), but it has the disadvantage of being invasive. In contrast, time-resolved magnetic resonance angiography (TR-MRA) is a useful, noninvasive imaging technique. The aim of this study was to compare the evaluation of DAVFs of the cavernous sinus (CS) using TR-MRA and DSA. TR-MRA and DSA were obtained in six patients with CS-DAVFs treated with endovascular surgery. TR-MRA and DSA before and after treatment were reviewed by one neuroradiologist without previous knowledge of the existence of CS-DAVFs for the detection and characterization (feeding artery and venous drainage) of CS-DAVFs. DSA showed six CS-DAVFs in the six patients. TR-MRA demonstrated a hyperintensity area in the CS at the arterial phase in six patients. DSA revealed feeding arteries and a drainage vein in all CS-DAVFs. In contrast, the feeding arteries could not be identified with TR-MRA. The details regarding venous drainage could only be speculated upon with TR-MRA as it was only partly visible on the TR-MRA images. DSA after embolization showed no CS-DAVFs in any of the six patients. TR-MRA showed no hyperintensity areas in the CS at the arterial phase in any of the six patients, and with no coil artifacts. In summary, TR-MRA could detect and diagnose CS-DAVF. However, the detail regarding anatomical feeders and draining veins remains poorly visualized by TR-MRA. In this small number of cases, TR-MRA can be a useful screening tool to detect CS-DAVF and possibly also to confirm persistent obliteration following definitive treatment.
数字减影血管造影（DSA）是确认硬脑膜动静脉瘘（DAVF）的首选方法，但它具有侵入性的缺点。相比之下，时间分辨磁共振血管造影（TR-MRA）是一种有用的、非侵入性的成像技术。本研究旨在比较 TR-MRA 和 DSA 对海绵窦（CS）DAVF 的评估。对 6 例经血管内治疗的 CS-DAVF 患者进行了 TR-MRA 和 DSA 检查。由一名神经放射科医生对治疗前后的 TR-MRA 和 DSA 进行回顾性分析，该医生事先不知道 CS-DAVF 的存在，以便对 CS-DAVF 的检测和特征（供血动脉和静脉引流）进行评估。DSA 显示 6 例患者中有 6 例 CS-DAVF。TR-MRA 显示 6 例患者在动脉期 CS 呈高信号区。DSA 显示所有 CS-DAVF 的供血动脉和引流静脉。相比之下，TR-MRA 无法识别供血动脉。由于 TR-MRA 图像仅部分可见，因此只能推测静脉引流的详细情况。栓塞后 DSA 显示 6 例患者中均无 CS-DAVF。TR-MRA 显示 6 例患者在动脉期 CS 均无高信号区，且无线圈伪影。总之，TR-MRA 可以检测和诊断 CS-DAVF。然而，TR-MRA 对解剖学供血动脉和引流静脉的细节显示仍不理想。在这少数情况下，TR-MRA 可以作为一种有用的筛查工具，用于检测 CS-DAVF，并可能在明确治疗后用于确认持续性闭塞。
