Ide Satomi, Kiyosue Hiro
Department of Radiology, Faculty of Medicine, Oita University.
No Shinkei Geka. 2021 Mar;49(2):362-367. doi: 10.11477/mf.1436204399.
Dural arteriovenous fistulas(dAVFs), which are arteriovenous shunts between the dural/epidural artery and dural vein and/or dural venous sinus, can cause various symptoms, and the risk of aggressive symptoms such as cerebral hemorrhage and venous infarction mainly depends on venous drainage patterns in patients. Patients with dAVFs with cortical venous reflux have a high risk of aggressive symptoms due to cerebral venous congestion or varix rupture, and they often develop brain edema and/or hemorrhage. In some cases, patients with dAVFs may have CT and MRI findings similar to those of patients with brain tumors. Key MRI findings suggesting dAVFs include multiple small flow voids representing cortical venous reflux adjacent to the hemorrhage or edematous lesion on T2WI and dot-like high-signal-intensity patterns of the feeding arteries and draining veins on time-of-flight MR angiography source images. Cerebral angiography should be performed quickly when dAVFs are suspected with careful assessment using CT/MRI to prevent further worsening of symptoms, particularly for lesions involving the brain stem and cerebellum.
硬脑膜动静脉瘘（dAVFs）是硬脑膜/硬膜外动脉与硬脑膜静脉和/或硬脑膜静脉窦之间的动静脉分流，可引起各种症状，脑出血和静脉梗死等侵袭性症状的风险主要取决于患者的静脉引流模式。伴有皮质静脉回流的dAVFs患者因脑静脉充血或静脉曲张破裂而出现侵袭性症状的风险较高，且常发生脑水肿和/或出血。在某些情况下，dAVFs患者的CT和MRI表现可能与脑肿瘤患者相似。提示dAVFs的关键MRI表现包括T2WI上与出血或水肿病变相邻的代表皮质静脉回流的多个小流空信号，以及时间飞跃磁共振血管造影源图像上供血动脉和引流静脉的点状高信号模式。当怀疑有dAVFs时，应迅速进行脑血管造影，并使用CT/MRI进行仔细评估，以防止症状进一步恶化，特别是对于累及脑干和小脑的病变。
