Beijer Tim R, van Dijk Ewoud J, de Vries Joost, Vermeer Sarah E, Prokop Mathias, Meijer Frederick J A
Department of Neurology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Clin Neurol Neurosurg. 2013 Aug;115(8):1313-6. doi: 10.1016/j.clineuro.2012.12.015. Epub 2013 Jan 5.
In the diagnostic work-up of patients suspected of a dural arteriovenous fistula (dAVF), imaging has a key role in order to diagnose the dAVF, assess its bleeding risk and choose optimal treatment strategy. Digital subtraction angiography (DSA) is the gold standard for the most detailed image of a dAVF. Nowadays four-dimensional CT angiography (4D-CTA) could possibly be an additional first-line tool in the work-up of a patient suspected of a dAVF. We describe three cases clinically suspected of a dAVF which had a diagnostic work-up with 4D-CTA as well as DSA. We evaluated the angioarchitecture of the dAVF both on 4D-CTA and DSA, with emphasis on the patterns of venous drainage as this is important in assessing the bleeding risk of a dAVF.
4D-CTA identified the dAVF, revealed its angioarchitecture and correctly differentiated different patterns of venous drainage (Borden type I, II and III) as confirmed on DSA. Although DSA has the advantage of higher spatial and temporal resolution, 4D-CTA seems to be a new useful non-invasive tool in the diagnostic work-up of a patient suspected of a dAVF.
在疑似硬脑膜动静脉瘘（dAVF）患者的诊断检查中，影像学对于诊断dAVF、评估其出血风险以及选择最佳治疗策略起着关键作用。数字减影血管造影（DSA）是获取dAVF最详细图像的金标准。如今，四维CT血管造影（4D-CTA）可能成为疑似dAVF患者检查中的另一种一线工具。我们描述了3例临床疑似dAVF的病例，这些病例接受了4D-CTA以及DSA的诊断检查。我们在4D-CTA和DSA上评估了dAVF的血管结构，重点关注静脉引流模式，因为这对于评估dAVF的出血风险很重要。
4D-CTA识别出了dAVF，揭示了其血管结构，并正确区分了不同的静脉引流模式（博登I型、II型和III型），DSA证实了这些结果。尽管DSA具有更高的空间和时间分辨率优势，但4D-CTA似乎是疑似dAVF患者诊断检查中一种新的有用的非侵入性工具。
