CT angiography and MR angiography in the evaluation of carotid cavernous sinus fistula prior to embolization: a comparison of techniques.
OBJECTIVE
This study compared CT angiography (CTA), MR angiography (MRA), and digital subtraction angiography (DSA) in elucidating the size and location of carotid cavernous sinus fistulas (CCFs) before embolization treatment.


METHODS
This was a retrospective study of 53 patients with angiographically confirmed CCF. All patients underwent pre- and postcontrast-enhanced CTA and DSA, and 50 patients also underwent MRA. Two neuroradiologists rated detectability of the fistula tract as "good," "moderate," or "poor" in source images obtained by using each procedure. The chi(2) test was used to compare the imaging modalities with respect to their ability to detect fistulas.


RESULTS
CTA did not differ significantly from DSA (P = .155), and both CTA (P = .001) and DSA (P = .007) performed significantly better than MRA in the population as a whole. Differences in performance among the methods, however, depended upon the segmental location of the fistula along the internal carotid artery (ICA). CTA and MRA were similar in detection of CCFs in patients with a fistula at segment 3. CTA significantly outperformed MRA in patients with a fistula at segment 4, who accounted for approximately half of the population.


CONCLUSIONS
CTA source imaging has proved itself as useful as DSA for detecting CCFs. Of the 2 noninvasive techniques, CTA performed better than MRA in the population as a whole and in most patients whose fistula was located at segment 4 or 5 of the ICA.
Chen
Clayton Chi-Chang
CC
Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan.
Chang
Patricia Chuen-Tsuei
PC
Shy
Cherng-Gueih
CG
Chen
Wen-Shien
WS
Hung
Hao-Chun
HC
D000293:Adolescent; D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000473:pathology; D020216:Carotid-Cavernous Sinus Fistula / Q000175:diagnosis* / Q000601:surgery / Q000628:therapy; D002426:Cavernous Sinus / Q000000981:diagnostic imaging / Q000473:pathology; D003287:Contrast Media; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D036542:Tomography, Spiral Computed
D003287:Contrast Media