Retrograde cortical and deep venous drainage in patients with intracranial dural arteriovenous fistulas: comparison of MR imaging and angiographic findings.
OBJECTIVE
We assessed MR imaging, specifically contrast-enhanced three-dimensional (3D) magnetization-prepared rapid gradient-echo (MP-RAGE), in evaluating retrograde venous drainage in patients with intracranial dural arteriovenous fistulas (dAVFs) that may result in catastrophic venous infarction or hemorrhage.


METHODS
Twenty-one patients with angiographically proved dAVFs underwent nonenhanced spin-echo (SE) and fast SE imaging, 3D fast imaging with steady-state precession, and enhanced SE and 3D MP-RAGE imaging. Retrograde venous drainage was categorized as cerebral cortical, deep cerebral, posterior fossa medullary, ophthalmic, or spinal venous. We assessed retrograde venous drainage and graded its severity. MR imaging and angiographic severities were correlated. Sensitivity, specificity, and accuracy were calculated to evaluate the diagnostic utility of each technique compared with conventional angiography. We retrospectively correlated angiograms and MR images.


RESULTS
Enhanced 3D MP-RAGE and T1-weighted SE images had higher diagnostic accuracy higher than nonenhanced images, especially when retrograde drainage involved cerebral cortical, posterior fossa, and spinal veins. Correlation of severity for enhanced MP-RAGE images and enhanced T1-weighted images with angiograms was good to excellent and better than that with nonenhanced images. All sequences had low diagnostic accuracy when drainage was via deep cerebral veins. On retrospective review, 3D MP-RAGE images showed two thrombotic inferior petrosal sinuses.


CONCLUSIONS
Enhanced MR images were superior to nonenhanced images in assessing retrograde venous drainage in intracranial dAVFs. Enhanced 3D MP-RAGE is superior to enhanced T1-weighted SE imaging for determining the route and severity of venous reflux because of its increased spatial resolution and ability to contiguously delineate the venous system.
Kitajima
Mika
M
Department of Radiology, Kumamoto University School of Medicine, Japan.
Hirai
Toshinori
T
Korogi
Yukunori
Y
Yamura
Masayuki
M
Kawanaka
Koichi
K
Ikushima
Ichiro
I
Hayashida
Yoshiko
Y
Yamashita
Yasuyuki
Y
Kuratsu
Junichi
J
D000368:Aged; D020785:Central Nervous System Vascular Malformations / Q000175:diagnosis* / Q000628:therapy*; D002533:Cerebral Angiography; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies