Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India.
Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India.
Clin Radiol. 2021 Sep;76(9):712.e1-712.e8. doi: 10.1016/j.crad.2021.05.008. Epub 2021 Jun 16.
To evaluate the utility of silent magnetic resonance angiography (MRA) in the diagnosis, characterisation, and therapeutic planning of intracranial dural arteriovenous fistula (DAVF).
Twenty consecutive patients with DAVF were enrolled prospectively and were evaluated using silent MRA and digital subtraction angiography (DSA) as a part of routine work-up. The diagnosis and location of fistula, Borden and Cognard classification, entire arterial feeders, and venous drainage were analysed. A therapeutic strategy was formulated, and the accessible route and vessel were predicted, which was confirmed on endovascular treatment.
Silent MRA was 100% sensitive and accurate for location and classification of fistulas. Silent MRA showed a sensitivity of 82% and 76.5% for entire arterial feeders and draining veins, which improved to a sensitivity of 90% and 94% when prominent feeders and immediate venous drainage was considered. Among the missed veins, thrombosed sinus, slow sinus flow, small calibre, reduced image quality were the causes. The therapeutic decision matched with DSA in all cases and silent MRA accurately identified the potential accessible feeder in 94% cases.
Silent MRA is a promising MR technique that can provide both diagnostic and therapeutic information similar to that obtained from DSA.
评估磁共振血管成像（MRA）在颅内硬脑膜动静脉瘘（DAVF）的诊断、特征描述和治疗计划中的作用。
连续 20 例 DAVF 患者前瞻性纳入研究，采用 silent MRA 和数字减影血管造影（DSA）作为常规检查的一部分进行评估。分析瘘管的诊断和位置、Borden 和 Cognard 分类、所有动脉供血动脉和静脉引流情况。制定治疗策略，并预测可及的入路和血管，在血管内治疗中得到证实。
silent MRA 对瘘管的位置和分类具有 100%的敏感性和准确性。silent MRA 对所有动脉供血动脉和引流静脉的敏感性分别为 82%和 76.5%，当考虑明显的供血动脉和直接的静脉引流时，敏感性分别提高至 90%和 94%。在漏诊的静脉中，静脉血栓形成、窦内血流缓慢、小口径、图像质量降低是导致漏诊的原因。在所有病例中，治疗决策与 DSA 相符，94%的病例 silent MRA 能够准确识别潜在的可及供血动脉。
silent MRA 是一种很有前途的磁共振技术，可提供与 DSA 相似的诊断和治疗信息。
