Detection and classification of cranial dural arteriovenous fistulas using 4D-CT angiography: initial experience.
OBJECTIVE
The criterion standard to diagnose and classify cranial DAVFs is DSA. Since this is invasive, relatively expensive and time-consuming, a noninvasive alternative is of interest. We aimed to evaluate the capabilities and pitfalls of 4D-CTA in a consecutive series of patients who presented with a newly diagnosed cranial DAVF, as demonstrated by conventional DSA.


METHODS
Eleven patients were included in this study after biplane DSA demonstrated a cranial DAVF. They subsequently underwent 4D-CTA imaging by using a 320-detector CT scanner. DSA and 4D-CTA studies were independently read by 2 blinded observers, by using a standardized scoring sheet. 4D-CTA results were analyzed with DSA as the criterion standard.


RESULTS
In 10 cases, there was full agreement between DSA and 4D-CTA regarding the Borden classification. However, in the remaining patient, a slow-filling DAVF with a low shunt volume was missed by both readers on 4D-CTA. In all 10 detected cases, ≥ 1 of the major contributing arteries could be identified with 4D-CTA. Although, by using DSA, the 2 observers identified additional arterial feeders in 7 and 8 cases, respectively, these discrepancies did not influence clinical decision making.


CONCLUSIONS
Although novel 4D-CTA imaging may not rule out a small slow-flow DAVF, it appears to be a valuable new adjunct in the noninvasive diagnostic work-up, treatment planning, and follow-up of patients with cranial DAVFs.
Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands. p.w.a.willems@lumc.nl
P W A
PW
Willems
P A
PA
Brouwer
J J
JJ
Barfett
K G
KG
terBrugge
T
T
Krings
D020785:Central Nervous System Vascular Malformations / Q000000981:diagnostic imaging*; D002533:Cerebral Angiography / Q000379:methods*; D002536:Cerebral Arteries / Q000002:abnormalities* / Q000000981:diagnostic imaging*; D002550:Cerebral Veins / Q000002:abnormalities* / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D015203:Reproducibility of Results; D055425:Respiratory-Gated Imaging Techniques / Q000379:methods; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*