title: Assessment of dural arteriovenous fistulas of the cavernous sinuses on 3D dynamic MR angiography.
abstract: OBJECTIVE
  Flow voids within the cavernous sinuses and/or certain venous drainage on spin-echo MR imaging and time-of-flight (TOF) flow enhancement on MR angiography (MRA) have indicated high-velocity shunt flow and have been used for screening patients with dural arteriovenous fistulas (DAVFs) of the cavernous sinuses. In this investigation, the capabilities of 3D dynamic MRA as a flow-independent approach and those of conventional MR imaging techniques were compared with selective angiography for the diagnosis of DAVFs of the cavernous sinuses.
  
  
  METHODS
  This retrospective study involved 18 patients with angiographically proved DAVFs of the cavernous sinuses and 12 control subjects. Sixteen partially overlapping sequential MR images were acquired on contrast-enhanced 3D dynamic MRA between the petrosal bone and the orbital roof. Two experienced observers blinded to the clinical data and results of angiography independently graded 3D dynamic MRA, fast spin-echo T2-weighted imaging (FSE T2WI), and TOF MRA.
  
  
  RESULTS
  The average area under the receiver operating characteristic curve values and interobserver kappa scores for the diagnosis of DAVFs on 3D dynamic MRA, FSE T2WI, and TOF MRA were 0.99, 0.89, and 0.95; and 0.92, 0.71, and 0.73, respectively. Those for the diagnosis of anterior, posterior, and retrograde cortical venous drainage on 3D dynamic MRA were 0.72, 0.95, and 0.81; and 0.56, 0.50, and 0.49, respectively.
  
  
  CONCLUSIONS
  In this small series, screening 3D dynamic MRA directly demonstrates DAVFs of the cavernous sinuses and has improved diagnostic capability.
authors.affiliation: Department of Radiology, Sapporo Medical University, School of Medicine, Sapporo, Japan. akibah@sapmed.ac.jp
authors.forename: H
authors.initials: H
authors.lastname: Akiba
authors.forename: M
authors.initials: M
authors.lastname: Tamakawa
authors.forename: H
authors.initials: H
authors.lastname: Hyodoh
authors.forename: K
authors.initials: K
authors.lastname: Hyodoh
authors.forename: N
authors.initials: N
authors.lastname: Yama
authors.forename: T
authors.initials: T
authors.lastname: Nonaka
authors.forename: Y
authors.initials: Y
authors.lastname: Minamida
authors.forename: M
authors.initials: M
authors.lastname: Hashimoto
authors.forename: M
authors.initials: M
authors.lastname: Hareyama
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001783:Blood Flow Velocity / Q000502:physiology; D016022:Case-Control Studies; D002426:Cavernous Sinus / Q000503:physiopathology; D020785:Central Nervous System Vascular Malformations / Q000175:diagnosis* / Q000503:physiopathology; D002533:Cerebral Angiography; D002550:Cerebral Veins / Q000503:physiopathology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity