Tortuous, engorged pial veins in intracranial dural arteriovenous fistulas: correlations with presentation, location, and MR findings in 122 patients.
OBJECTIVE
Tortuous, engorged veins can be identified on the venous phase of the brain circulation in patients with venous congestion related to an intracranial dural arteriovenous fistula (DAVF). The term pseudophlebitic pattern (PPP) has been used to describe this finding. The purpose of this study was to determine the prevalence of PPP in patients with intracranial DAVF and to analyze the relationship of this sign to presentation, location of the fistula, presence of retrograde leptomeningeal venous drainage, and MR findings.


METHODS
We retrospectively reviewed the charts and imaging findings of 130 patients with intracranial DAVF. In 122 patients the venous phase of the brain circulation was adequately assessed. The PPP was graded as mild, moderate, or severe.


RESULTS
PPP was found in 51 patients (42%). Thirty-two (73%) of the 44 patients who had a hemorrhage, neurologic deficit, or seizure had PPP as compared with 16 (21%) of the 75 who had a bruit or orbital signs. The three patients with either congestive heart failure or increasing head circumference had PPP. Fourteen (88%) of the 16 who had fistula of the superior sagittal sinus, straight sinus, or superior petrosal sinus had PPP. PPP was seen in 46 (81%) of 57 patients who had retrograde leptomeningeal venous drainage and in five (8%) of the 65 who had only sinosal drainage. Fourteen (88%) of the 16 who had white matter T2 hyperintensity on MR images had severe PPP.


CONCLUSIONS
The PPP reflects venous congestion and is associated with an aggressive presentation with or without retrograde leptomeningeal venous drainage. PPP may be a useful prognostic indicator and should be considered in treatment decisions.
Willinsky
R
R
Hospital, Western Division, Ontario, Canada.
Goyal
M
M
terBrugge
K
K
Montanera
W
W
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001164:Arteriovenous Fistula / Q000150:complications / Q000175:diagnosis*; D002550:Cerebral Veins / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D004388:Dura Mater / Q000098:blood supply*; D005260:Female; D006801:Humans; D007223:Infant; D002538:Intracranial Arteriovenous Malformations / Q000150:complications / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010689:Phlebitis / Q000150:complications / Q000175:diagnosis; D010841:Pia Mater / Q000098:blood supply*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed