Zhao Peng-fei, Pamier Abudukadi, Xian Jun-fang, Liang Xi-hong, Yan Fei, Du Wang, Lü Han, Wang Zhen-chang
Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China.
Department of Radiology, Beijing Youyi Hospital, Capital Medical University, Beijing 100050, China. Email:
Zhonghua Yi Xue Za Zhi. 2013 Sep 3;93(33):2622-6.
To evaluate the sensitivity and specificity of computed tomographic angiography ( CTA) for dural arteriovenous fistulas ( DAVFs) in patients presenting with pulsatile tinnitus( PT).
The clinical and imaging data were collected for all patients undergoing CTA for PT from 2008 to 2012. Nine PT patients with DAVFs confirmed by digital subtraction angiography ( DSA) and 9 age and gender-matched control PT patients without DAVFs were selected. The CTA images were blindly analyzed by two experienced neuroradiologists for the following signs: asymmetric venous collaterals in extracranial space , asymmetric attenuation of internal jugular vein ( IJV) , asymmetric external carotid artery( ECA) branches, "shaggy" appearance of dural venous sinus, multiple transcalvarial channels, enlarged foramen spinosum, asymmetric cavernous sinus and enlarged cortical veins.
The sensitivities of the following DAVFs signs were quite different: asymmetric attenuation of IJV ( 89% ) , asymmetric venous collaterals ( 89%) , asymmetric ECA branches ( 78%) , shaggy dural venous sinus ( 67%) , multiple transcalvarial channels (67%), enlarged foramen spinosum (56%), stenosis of venous sinus (33%) and asymmetric cavernous sinus ( 2 2 % ) . The presence of asymmetric attenuation of IJV , asymmetric ECA branches, shaggy dural venous sinus, multiple transcalvarial channels and asymmetric cavernous sinus all demonstrated a highly specificity of 100% while the presence of asymmetric venous collaterals and enlarged foramen spinosum had a specificity of 89% . The presence of stenosis of venous sinus revealed a specificity of 78%. Enlarged cortical veins were all absent.
CTA may be used as a screening examination for DA VFs in PT patients. The presence of asymmetric venous collaterals, asymmetric attenuation of UV,asymmetric ECA branches, shaggy dural venous sinus and multiple transcalvarial channels has a high sensitivity and specificity for diagnosis. Enlarged ECA branches usually serve as DA VFs feeders.Meanwhile, DA VF should be considered in PT patients when multiple transcalvarial channels and enlarged foramen spinosum are detected on high-resolution CT of temporal bone.
评估计算机断层血管造影(CTA)对搏动性耳鸣(PT)患者硬脑膜动静脉瘘(DAVF)的敏感性和特异性。
收集2008年至2012年期间所有因PT接受CTA检查的患者的临床和影像资料。选择9例经数字减影血管造影(DSA)确诊为DAVF的PT患者和9例年龄、性别匹配的无DAVF的对照PT患者。由两名经验丰富的神经放射科医生对CTA图像进行盲法分析,观察以下征象:颅外间隙不对称静脉侧支、颈内静脉(IJV)不对称衰减、颈外动脉(ECA)分支不对称、硬脑膜静脉窦“粗糙”外观、多个经颅通道、棘孔扩大、海绵窦不对称和皮质静脉增粗。
以下DAVF征象的敏感性差异较大:IJV不对称衰减(89%)、不对称静脉侧支(89%)、ECA分支不对称(78%)、硬脑膜静脉窦粗糙(67%)、多个经颅通道(67%)、棘孔扩大(56%)、静脉窦狭窄(33%)和海绵窦不对称(22%)。IJV不对称衰减、ECA分支不对称、硬脑膜静脉窦粗糙、多个经颅通道和海绵窦不对称的存在均显示出100%的高特异性,而不对称静脉侧支和棘孔扩大的存在特异性为89%。静脉窦狭窄的存在显示特异性为78%。均未发现皮质静脉增粗。
CTA可作为PT患者DAVF的筛查检查。不对称静脉侧支、IJV不对称衰减、ECA分支不对称、硬脑膜静脉窦粗糙和多个经颅通道的存在对诊断具有较高的敏感性和特异性。ECA分支增粗通常是DAVF的供血血管。同时,当颞骨高分辨率CT上检测到多个经颅通道和棘孔扩大时,PT患者应考虑DAVF。