Three-dimensional FISP imaging in the evaluation of carotid cavernous fistula: comparison with contrast-enhanced CT and spin-echo MR.
OBJECTIVE
The purpose of this study was to assess the value of three-dimensional fast imaging with steady-state precession (FISP) MR sequences relative to contrast-enhanced CT and spin-echo MR imaging in the diagnosis of carotid cavernous fistula (CCF).


METHODS
Seventeen patients with 19 angiographically proved CCFs had contrast-enhanced CT, spin-echo MR imaging, and 3-D FISP imaging. Three observers assessed these imaging studies as well as those of 43 control sides in a blinded manner for the presence or absence of CCF. Receiver operating characteristic analysis was used to assess the diagnostic utility of each imaging technique. In a nonblinded study, contrast-enhanced 3-D FISP images were also evaluated.


RESULTS
Higher diagnostic accuracy was obtained with 3-D FISP sequences, as the shunt flow within the cavernous sinus was well seen. Sensitivity of 3-D FISP images was 83% and specificity was 100% in the blinded study. In the receiver operating characteristic analysis, the diagnostic performance of observers was found to be better with the 3-D FISP images than with the spin-echo MR images. Although there were no significant difference between 3-D FISP and contrast-enhanced CT, higher diagnostic performance was obtained with 3-D FISP images. In three CCFs without anterior drainage, a diagnosis was made only from the 3-D FISP images. The contrast-enhanced 3-D FISP images were not helpful, since the cavernous sinuses enhanced.


CONCLUSIONS
Three-dimensional FISP imaging is superior to spin-echo MR imaging and contrast-enhanced CT in the diagnosis of CCF. Contrast-enhanced 3-D FISP images are not helpful for the evaluation of CCF.
Hirai
T
T
Department of Radiology, Kumamoto University School of Medicine, Honjo, Japan.
Korogi
Y
Y
Hamatake
S
S
Ikushima
I
I
Sugahara
T
T
Sigematsu
Y
Y
Higashida
Y
Y
Takahashi
M
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D001164:Arteriovenous Fistula / Q000175:diagnosis*; D002340:Carotid Artery Diseases / Q000175:diagnosis*; D002343:Carotid Artery, Internal / Q000473:pathology*; D002426:Cavernous Sinus / Q000473:pathology*; D002533:Cerebral Angiography; D003287:Contrast Media; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000295:instrumentation*; D007091:Image Processing, Computer-Assisted / Q000295:instrumentation*; D008279:Magnetic Resonance Imaging / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000295:instrumentation*
D003287:Contrast Media