title: MRI and MR angiography findings to differentiate jugular venous reflux from cavernous dural arteriovenous fistula.
abstract: OBJECTIVE
  Both jugular venous reflux (JVR) and cavernous dural arteriovenous fistula (DAVF) manifest as abnormal venous signal intensities on time-of-flight (TOF) MR angiography (MRA). We investigated brain MRI and MRA findings that might differentiate JVR from cavernous DAVF.
  
  
  METHODS
  Forty-one patients with abnormal venous signal intensities on TOF MRA in the cavernous sinus and its vicinity were selected from 1508 patients who had undergone TOF MRA over the previous 6 months. For comparison, the examinations of 26 patients with cavernous DAVF who had undergone imaging over the previous 8 years were collected. The following findings were assessed: the side and location of abnormal venous signal intensities on intracranial TOF MRA; the signal intensity of the proximal jugular vein on T2-weighted imaging; whether there was early opacification of the cavernous sinus in the arterial phase of contrast-enhanced MRA (CE-MRA); the side of jugular venous drainage in the arteriovenous phase of CE-MRA; and whether retrograde jugular venous flow was seen on neck TOF MRA.
  
  
  RESULTS
  Abnormal venous signal intensities were seen on the left side in 73% of patients with JVR and 58% of patients with cavernous DAVF; involvement of the cavernous sinus was found in 12% of patients with JVR and 100% of patients with cavernous DAVF. Increased signal intensity in the ipsilateral jugular vein on T2-weighted imaging was found in 73% of JVR patients and 4% of cavernous DAVF patients. Early opacification of the cavernous sinus in the arterial phase of CE-MRA, ipsilateral jugular venous drainage in the arteriovenous phase of CE-MRA, and ipsilateral retrograde jugular venous flow on neck TOF MRA were found in 0%, 0%, and 63%, respectively, of JVR patients and in 100%, 100%, and 0%, respectively, of cavernous DAVF patients.
  
  
  CONCLUSIONS
  JVR and cavernous DAVF can be differentiated from one another using MRI and MRA.
authors.affiliation: 1 Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Korea.
authors.forename: Eunhee
authors.initials: E
authors.lastname: Kim
authors.forename: Jae Hyoung
authors.initials: JH
authors.lastname: Kim
authors.forename: Byung Se
authors.initials: BS
authors.lastname: Choi
authors.forename: Cheolkyu
authors.initials: C
authors.lastname: Jung
authors.forename: Dong Hoon
authors.initials: DH
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002426:Cavernous Sinus / Q000473:pathology*; D020785:Central Nervous System Vascular Malformations / Q000175:diagnosis*; D002533:Cerebral Angiography; D002560:Cerebrovascular Circulation / Q000502:physiology; D003287:Contrast Media; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007601:Jugular Veins / Q000473:pathology*; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds; D012189:Retrospective Studies
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; C090600:gadobutrol; C064925:gadodiamide; D019786:Gadolinium DTPA