title: Utility of source images of three-dimensional time-of-flight magnetic resonance angiography in the diagnosis of indirect carotid-cavernous sinus fistulas.
abstract: BACKGROUND
  We sought to assess the relative contribution of magnetic resonance imaging (MRI), maximum intensity projection (MIP), and source images of three-dimensional (3D) time-of-flight (TOF) magnetic resonance angiography (MRA) to the diagnosis of indirect (dural) carotid-cavernous sinus fistulas (CCFs).
  
  
  METHODS
  MRI and 3D TOF MRA were obtained in eight consecutive patients with indirect CCFs confirmed by conventional catheter angiography. Two radiologists masked to the angiographic results reviewed images retrospectively to evaluate the efficacy of MRI and 3D TOF MRA source and MIP images in the diagnosis of CCF.
  
  
  RESULTS
  MRI disclosed CCF in five of eight cases; MIP images of TOF MRA disclosed CCF in four cases; source images of TOF MRA disclosed all eight CCF cases.
  
  
  CONCLUSIONS
  The MRA source images are indispensable for a confirmatory diagnosis of indirect (dural) CCF. Underdiagnosis may occur by relying on MRI or 3D TOF MIP images alone.
authors.affiliation: Department of Diagnostic Radiology, Shin Kong Wu Ho-Su Memorial Hospital, Shih Lin, Taipei, Taiwan. yuhfeng.tsai@msa.hinet.net
authors.forename: Yuh-Feng
authors.initials: YF
authors.lastname: Tsai
authors.forename: Liang-Kong
authors.initials: LK
authors.lastname: Chen
authors.forename: Cheng-Tau
authors.initials: CT
authors.lastname: Su
authors.forename: Ta-Nien
authors.initials: TN
authors.lastname: Lu
authors.forename: Chin-Chu
authors.initials: CC
authors.lastname: Wu
authors.forename: Chu-Jen
authors.initials: CJ
authors.lastname: Kuo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020216:Carotid-Cavernous Sinus Fistula / Q000473:pathology*; D002533:Cerebral Angiography / Q000379:methods; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity