Department of Neurology and Stroke Centre, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
AJNR Am J Neuroradiol. 2013 Mar;34(3):547-51. doi: 10.3174/ajnr.A3273. Epub 2012 Sep 13.
The occipital artery is usually a main feeding artery of an intracranial dural arteriovenous fistula. The aim of this study was to establish the role of the OA in the diagnosis of DAVFs by using duplex sonography.
We first compared the clinical features between patients with DAVFs having and not having the OA as one of feeding arteries in 181 consecutive patients with DAVFs. Second, we investigated the OA by using duplex sonography in 60 control subjects to test the accessibility. Finally, we studied 24 DAVF and 60 non-DAVF patients to validate the diagnostic performances of duplex sonography. Hemodynamic parameters, including the resistance index and flow velocity, were analyzed.
Half of the DAVFs (51%) had the OA as one of feeding arteries. DAVFs with the OA as one of the feeders were more likely located at noncavernous sinuses; to belong to types IIb, IIa+b, III, IV, or V; and to be associated with aggressive manifestations compared with DAVFs without the OA as a feeder (P < .05). Accessibility of the OA by using duplex sonography was 100%. The resistance index was lower and flow velocity was higher in the OA among patients with DAVFs compared with control subjects (P < .001). An OA resistance index <0.76 yielded a sensitivity and specificity of 96% and 97%, respectively, for the diagnosis of a DAVF.
The OA resistance index can be used to screen for DAVFs having the OA as one of feeding arteries, and this kind of DAVF was usually associated with nonbenign clinical courses.
枕动脉通常是颅内硬脑膜动静脉瘘（dural arteriovenous fistula，DAVF）的主要供血动脉。本研究旨在通过双功超声探讨枕动脉（occiptal artery，OA）在 DAVF 诊断中的作用。
首先，我们比较了 181 例 DAVF 患者中存在和不存在 OA 作为供血动脉的两组患者的临床特征。其次，我们对 60 例对照者进行了双功超声检查，以测试 OA 的可检测性。最后，我们对 24 例 DAVF 患者和 60 例非 DAVF 患者进行了研究，以验证双功超声的诊断效能。分析了包括阻力指数和血流速度在内的血流动力学参数。
半数 DAVF（51%）存在 OA 作为供血动脉之一。与不存在 OA 作为供血动脉的 DAVF 相比，具有 OA 作为供血动脉之一的 DAVF 更可能位于非海绵窦内；属于Ⅱb、Ⅱa+b、Ⅲ、Ⅳ或Ⅴ型；并且与侵袭性表现相关（P <.05）。双功超声检查 OA 的可检测性为 100%。与对照组相比，DAVF 患者的 OA 阻力指数较低，血流速度较高（P <.001）。OA 阻力指数<0.76 对 DAVF 的诊断具有 96%的敏感性和 97%的特异性。
OA 阻力指数可用于筛查具有 OA 作为供血动脉之一的 DAVF，此类 DAVF 通常与非良性临床病程相关。
