Association of pial venous reflux with hemorrhage or edema in dural arteriovenous fistula.
OBJECTIVE
We investigated whether pial venous reflux (PVR) is associated with hemorrhage or edema in dural arteriovenous fistula (DAVF).


METHODS
We evaluated the association of hemorrhage or edema with the occurrence of PVR or cortical venous reflux (CVR) in 222 patients with DAVF. We determined whether angiographic findings of PVR or CVR (more than Borden I or Cognard IIa) were associated with symptoms, lesion location, or brain lesion (hemorrhage or edema). We evaluated the lesion progression or the follow-up results after obliteration of the DAVF.


RESULTS
Hemorrhage or edema developed in 18% (40/222) of the patients with DAVF and 55% (40/72) of the patients with PVR. There were 2 patterns of PVR associated with hemorrhage or edema: (1) PVR in any particular CVR territory (75%), and (2) direct PVR not via CVR (25%). The presence of brain lesion increased the odds of presence of PVR by 4.09 times compared to the group without brain lesion (95% confidence interval = 1.570-11.394, p = 0.004). Brain edema caused by PVR was reversible after obliteration of the fistula and may have progressed to hemorrhage without proper patient management performed within several weeks after the initial presentation.


CONCLUSIONS
Our results show that PVR is more closely associated with the hemorrhage or edema than CVR in patients with DAVF. PVR can occur not only as a part of CVR but also directly in certain types of DAVF.
From the Department of Radiology and Research Institute of Radiology (L.B.Z., D.C.S., D.-G.L., S.J.K., D.H.L.) and Department of Neurology (J.S.K.), University of Ulsan, College of Medicine, and Department of Epidemiology and Biostatistics (S.H.), Asan Medical Center, Seoul, Korea; Department of Radiology (L.B.Z.), First Affiliated Hospital of Nanjing Medical University, Nanjing, China; and Department of Radiology (J.K.K.), Chung-Ang University, College of Medicine, Seoul, Korea.
Lin Bo
LB
Zhao
From the Department of Radiology and Research Institute of Radiology (L.B.Z., D.C.S., D.-G.L., S.J.K., D.H.L.) and Department of Neurology (J.S.K.), University of Ulsan, College of Medicine, and Department of Epidemiology and Biostatistics (S.H.), Asan Medical Center, Seoul, Korea; Department of Radiology (L.B.Z.), First Affiliated Hospital of Nanjing Medical University, Nanjing, China; and Department of Radiology (J.K.K.), Chung-Ang University, College of Medicine, Seoul, Korea. dcsuh@amc.seoul.kr.
Dae Chul
DC
Suh
From the Department of Radiology and Research Institute of Radiology (L.B.Z., D.C.S., D.-G.L., S.J.K., D.H.L.) and Department of Neurology (J.S.K.), University of Ulsan, College of Medicine, and Department of Epidemiology and Biostatistics (S.H.), Asan Medical Center, Seoul, Korea; Department of Radiology (L.B.Z.), First Affiliated Hospital of Nanjing Medical University, Nanjing, China; and Department of Radiology (J.K.K.), Chung-Ang University, College of Medicine, Seoul, Korea.
Dong-Geun
DG
Lee
From the Department of Radiology and Research Institute of Radiology (L.B.Z., D.C.S., D.-G.L., S.J.K., D.H.L.) and Department of Neurology (J.S.K.), University of Ulsan, College of Medicine, and Department of Epidemiology and Biostatistics (S.H.), Asan Medical Center, Seoul, Korea; Department of Radiology (L.B.Z.), First Affiliated Hospital of Nanjing Medical University, Nanjing, China; and Department of Radiology (J.K.K.), Chung-Ang University, College of Medicine, Seoul, Korea.
Sang Joon
SJ
Kim
From the Department of Radiology and Research Institute of Radiology (L.B.Z., D.C.S., D.-G.L., S.J.K., D.H.L.) and Department of Neurology (J.S.K.), University of Ulsan, College of Medicine, and Department of Epidemiology and Biostatistics (S.H.), Asan Medical Center, Seoul, Korea; Department of Radiology (L.B.Z.), First Affiliated Hospital of Nanjing Medical University, Nanjing, China; and Department of Radiology (J.K.K.), Chung-Ang University, College of Medicine, Seoul, Korea.
Jae Kyun
JK
Kim
From the Department of Radiology and Research Institute of Radiology (L.B.Z., D.C.S., D.-G.L., S.J.K., D.H.L.) and Department of Neurology (J.S.K.), University of Ulsan, College of Medicine, and Department of Epidemiology and Biostatistics (S.H.), Asan Medical Center, Seoul, Korea; Department of Radiology (L.B.Z.), First Affiliated Hospital of Nanjing Medical University, Nanjing, China; and Department of Radiology (J.K.K.), Chung-Ang University, College of Medicine, Seoul, Korea.
Seungbong
S
Han
From the Department of Radiology and Research Institute of Radiology (L.B.Z., D.C.S., D.-G.L., S.J.K., D.H.L.) and Department of Neurology (J.S.K.), University of Ulsan, College of Medicine, and Department of Epidemiology and Biostatistics (S.H.), Asan Medical Center, Seoul, Korea; Department of Radiology (L.B.Z.), First Affiliated Hospital of Nanjing Medical University, Nanjing, China; and Department of Radiology (J.K.K.), Chung-Ang University, College of Medicine, Seoul, Korea.
Deok Hee
DH
Lee
From the Department of Radiology and Research Institute of Radiology (L.B.Z., D.C.S., D.-G.L., S.J.K., D.H.L.) and Department of Neurology (J.S.K.), University of Ulsan, College of Medicine, and Department of Epidemiology and Biostatistics (S.H.), Asan Medical Center, Seoul, Korea; Department of Radiology (L.B.Z.), First Affiliated Hospital of Nanjing Medical University, Nanjing, China; and Department of Radiology (J.K.K.), Chung-Ang University, College of Medicine, Seoul, Korea.
Jong Sung
JS
Kim
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001929:Brain Edema / Q000473:pathology*; D020785:Central Nervous System Vascular Malformations / Q000473:pathology*; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010841:Pia Mater / Q000098:blood supply* / Q000473:pathology*; D011446:Prospective Studies; D055815:Young Adult