Iwamura Masatoshi, Midorikawa Hiroshi, Kakuta Akihisa, Shibutani Koichi
Department of Interventional Neuroradiology, Aomori Prefectural Central Hospital, Aomori, Aomori, Japan.
Department of Radiology, Aomori Prefectural Central Hospital, Aomori, Aomori, Japan.
J Neuroendovasc Ther. 2021;15(2):113-119. doi: 10.5797/jnet.cr.2019-0119. Epub 2020 Sep 17.
We report the case of a patient in whom arterial spin labeling (ASL) was useful for assessing the effects of treatment for a transverse-sigmoid sinus dural arteriovenous fistula (TSS-dAVF).
The patient was a 65-year-old man. Cerebral angiography demonstrated an aggressive dAVF involving the TSS, superior sagittal sinus (SSS), and the sinus confluence, with severe cortical and deep venous reflux. We performed multiple transarterial and transvenous embolizations for the TSS and sinus confluence lesion. The shunt disappeared almost completely after embolization. A high signal intensity that had been apparent in the SSS and straight sinus (StS) on ASL imaging before embolization disappeared after embolization. ASL imaging 3 months after embolization revealed slightly a high signal intensity in the StS, which was considered to be due to recurrence of the lesion. Moreover, recurrence of the confluence and TSS-dAVF was observed on cerebral angiography 6 months after embolization. As additional embolization was considered difficult, radiation therapy was recommended, but the patient refused; therefore, follow-up was performed. As ASL imaging findings were consistent with cerebral angiography findings, careful examination and monitoring of changes on ASL imaging were subsequently performed.
Follow-up using ASL imaging is useful to assess the effects of treatment performed for a dAVF.
我们报告一例动脉自旋标记（ASL）有助于评估横窦-乙状窦硬脑膜动静脉瘘（TSS-dAVF）治疗效果的患者。
患者为一名65岁男性。脑血管造影显示为侵袭性硬脑膜动静脉瘘，累及横窦、上矢状窦（SSS）和窦汇，伴有严重的皮质和深部静脉逆流。我们对横窦和窦汇病变进行了多次经动脉和经静脉栓塞治疗。栓塞后分流几乎完全消失。栓塞前ASL成像中在SSS和直窦（StS）中明显的高信号强度在栓塞后消失。栓塞后3个月的ASL成像显示StS中有轻微的高信号强度，这被认为是由于病变复发所致。此外，栓塞后6个月的脑血管造影显示窦汇和TSS-dAVF复发。由于考虑再次栓塞困难，建议进行放射治疗，但患者拒绝；因此，进行了随访。由于ASL成像结果与脑血管造影结果一致，随后对ASL成像的变化进行了仔细检查和监测。
使用ASL成像进行随访有助于评估对硬脑膜动静脉瘘所进行治疗的效果。
