Diagnosis of carotid-cavernous fistulas with magnetic resonance angiography--demonstrating the draining veins utilizing 3-D time-of-flight and 3-D phase-contrast techniques.

This study assessed the ability to diagnose carotid-cavernous fistulas (CCFs) non-invasively using magnetic resonance angiography (MRA). Both three-dimensional time-of-flight (3-D TOF) MRA and three-dimensional phase-contrast (3-D PC) MRA were compared with conventional cerebral angiography in nine patients with CCFs. CCFs were grouped according to Barrow's classification. In all cases, 3-D TOF MRA revealed an inferior petrosal sinus as a draining vein. 3-D PC MRA demonstrated a dilated and tortuous superior ophthalmic vein (SOV) and reflux of the SOV in seven patients. In conclusion, CCFs can be diagnosed with MRA alone by demonstrating the drainging veins.