Takamatsu Seishiro, Suzuki Kohei, Murakami Yu, Nomura Kei, Yamamoto Junkoh, Nishizawa Shigeru
Department of Neurosurgery, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan.
Seirei Center for Health Promotion and Preventive Medicine, Hamamatsu, Shizuoka, Japan.
Radiol Case Rep. 2021 Apr 30;16(7):1655-1659. doi: 10.1016/j.radcr.2021.04.006. eCollection 2021 Jul.
In the diagnosis of an intracranial dural arteriovenous fistula (DAVF), arterial spin labeling (ASL), a sequence of magnetic resonance imaging (MRI) to depict high-blood-flow intracranial lesions, has been reported as a useful and noninvasive tool, not only to predict the presence of cortical venous drainage and draining veins, but also to confirm persistent obliteration after treatment. However, such utility of ASL has not been reported in DAVF of the craniocervical junction (CCJDAVF) because of the rarity of this disease and uncertainty in the acquisition of precise images. We report a case of CCJDAVF presenting with myelopathy. Preoperative ASL images showed an abnormal high-intensity signal in the craniocervical junction, consistent with the anterior spinal vein and draining veins, which were also identified by digital subtraction angiography. After successful surgical treatment for the disease, MRI and 4-dimensional computed tomography angiography (4DCTA) confirmed complete disappearance of CCJDAVF. The ASL images also showed no abnormal intensity signal. The patient was followed-up using ASL, and no recurrence of high-intensity signal was observed. As repetitive image examination is mandatory in the follow-up of a patient with DAVF to exclude recurrence, ASL is highly beneficial because of the unnecessity of an exogenous contrast medium and high credibility to depict the disease. The craniocervical junction may be out of the field of view in routine MRI. Special attention must be paid to setting the field of view and post labeling delay (PLD) to obtain precise images of ASL in CCJDAVF.
在颅内硬脑膜动静脉瘘（DAVF）的诊断中，动脉自旋标记（ASL）作为一种磁共振成像（MRI）序列，用于描绘高血流的颅内病变，已被报道为一种有用的非侵入性工具，不仅可以预测皮质静脉引流和引流静脉的存在，还可以确认治疗后是否持续闭塞。然而，由于这种疾病罕见且难以获得精确图像，ASL在颅颈交界区DAVF（CCJDAVF）中的这种效用尚未见报道。我们报告一例以脊髓病为表现的CCJDAVF病例。术前ASL图像显示颅颈交界区有异常高信号，与脊髓前静脉和引流静脉一致，数字减影血管造影也证实了这些情况。该疾病成功手术治疗后，MRI和四维计算机断层血管造影（4DCTA）证实CCJDAVF完全消失。ASL图像也未显示异常强度信号。对该患者进行ASL随访，未观察到高强度信号复发。由于在DAVF患者随访中必须进行重复图像检查以排除复发，ASL非常有益，因为它无需使用外源性对比剂且在描绘疾病方面具有很高的可信度。在常规MRI中，颅颈交界区可能不在视野范围内。在CCJDAVF中获取精确的ASL图像时，必须特别注意设置视野和标记后延迟（PLD）。
