Department of Medical Imaging and Radiology, Hospital and Medical College, National Taiwan University, Taipei, Taiwan.
Department of Medical Imaging, Fu Jen Catholic University and Hospital, New Taipei City, Taiwan.
J Neurointerv Surg. 2018 Nov;10(11):1114-1119. doi: 10.1136/neurintsurg-2017-013660. Epub 2018 Feb 19.
Engorged medullary vein (EMV) in patients with intracranial dural arteriovenous fistula (DAVF) suggests venous congestion. The aim of this study is to investigate its prevalence, pattern, and correlation with clinical findings.
CT angiography (CTA) raw data of DAVF were used for multiplanar reconstruction and then analyzed for the presence and pattern of EMV, which is defined as a dilated vein in the cerebral white matter. Patients with EMV were divided into two groups: regional and extensive. Regional type is defined as EMV limited to one cerebral hemisphere or cerebellum without evidence of subcortical calcification. Extensive type is defined as EMV involvement of more than one cerebral hemisphere or both the cerebrum and cerebellum. Descriptive analysis of clinical information, DAVF characteristics, and other imaging findings was conducted. Clinical information, including demographic data, clinical presentation, and hemorrhage, were correlated with both types of EMV.
Among 192 eligible patients with DAVF, 71 (37%) had EMV. Patients with EMV were older (63 years vs 56 years, P=0.02), with DAVF more often at the transverse and sigmoid sinus (P<0.001), and more often presented with aggressive symptoms (59% vs 34%, P=0.02) than non-EMV patients, but there was no difference in the presentation of hemorrhage (15% vs 16%, P=0.99). Patients with regional EMV had a higher proportion of hemorrhage than those with the extensive type (24% vs 0%, P=0.006).
EMV in patients with DAVF is associated with an aggressive manifestation. Regional type EMV is associated with a higher risk of a hemorrhagic presentation.
颅内硬脑膜动静脉瘘（DAVF）患者的充血性髓静脉（EMV）提示静脉充血。本研究旨在探讨其发生率、模式及其与临床发现的相关性。
使用 DAVF 的 CT 血管造影（CTA）原始数据进行多平面重建，然后分析 EMV 的存在和模式，EMV 定义为脑白质中扩张的静脉。将存在 EMV 的患者分为两组：局限性和广泛性。局限性类型定义为 EMV 局限于一个大脑半球或小脑，无皮质下钙化证据。广泛性类型定义为 EMV 累及一个以上大脑半球或大脑和小脑。对临床信息、DAVF 特征和其他影像学发现进行描述性分析。将临床信息（包括人口统计学数据、临床表现和出血）与两种类型的 EMV 相关联。
在 192 例符合条件的 DAVF 患者中，有 71 例（37%）存在 EMV。存在 EMV 的患者年龄更大（63 岁比 56 岁，P=0.02），DAVF 更常见于横窦和乙状窦（P<0.001），且更常表现为侵袭性症状（59%比 34%，P=0.02），而非 EMV 患者，但是出血的表现没有差异（15%比 16%，P=0.99）。局限性 EMV 患者比广泛性 EMV 患者出血的比例更高（24%比 0%，P=0.006）。
DAVF 患者的 EMV 与侵袭性表现相关。局限性类型的 EMV 与出血表现的风险更高相关。
