title: Orbital color Doppler ultrasound as noninvasive tool in the diagnosis of anterior-draining carotid-cavernous fistula.
abstract: OBJECTIVE
  To investigate the role of orbital color Doppler ultrasound (OCDUS) in the diagnosis of carotid-cavernous fistula (CCF) with anterior drainage and particularly whether a negative OCDUS could avoid an invasive diagnostic cerebral angiography (DSA).
  
  
  METHODS
  Twenty-two consecutive patients with ophthalmic signs suspecting CCF were submitted to ophthalmologic examination, OCDUS and DSA. CCF diagnosis with OCDUS was based on the finding of a reversed, arterialized and low-resistive-index (RI <0.5) blood flow in the superior ophthalmic vein (SOV). Sensibility, specificity, PPV, NPV, and accuracy of OCDUS were calculated considering both patients and eyes, using DSA as gold standard.
  
  
  RESULTS
  DSA demonstrated 20 CCFs in 18 patients. Considering the patients, in 18/22 CCF diagnosis was positive at OCDUS and DSA while 4/22 were negative at both. Considering the eyes, in 24/43 CCF diagnosis was positive at both DSA and OCDUS (total eyes = 43, due to one case of SOV thrombosis). In 19/43 eyes diagnosis was negative at both OCDUS and DSA. So sensitivity, specificity, PPV, NPV, and accuracy of OCDUS in the patients and eyes analysis were all 100 %.
  
  
  CONCLUSIONS
  OCDUS is a reliable, noninvasive tool in the diagnosis of CCF; a negative OCDUS could avoid an invasive DSA in patients suspected for anterior-draining CCF.
authors.affiliation: Department of Radiology, San Raffaele Scientific Institute - Vita Salute University, Via Olgettina, 60, 20132, Milan, Italy. venturini.massimo@hsr.it.
authors.forename: Massimo
authors.initials: M
authors.lastname: Venturini
authors.affiliation: Department of Radiology, San Raffaele Scientific Institute - Vita Salute University, Via Olgettina, 60, 20132, Milan, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Cristel
authors.affiliation: Department of Ophthalmology, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Stefania Bianchi
authors.initials: SB
authors.lastname: Marzoli
authors.affiliation: Department of Neuroradiology, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Simionato
authors.affiliation: Department of Radiology, San Raffaele Scientific Institute - Vita Salute University, Via Olgettina, 60, 20132, Milan, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Agostini
authors.affiliation: Department of Ophthalmology, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Piero
authors.initials: P
authors.lastname: Barboni
authors.affiliation: Department of Radiology, San Raffaele Scientific Institute - Vita Salute University, Via Olgettina, 60, 20132, Milan, Italy.|Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: De Cobelli
authors.affiliation: Department of Neuroradiology, San Raffaele Scientific Institute, Milan, Italy.|Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Falini
authors.affiliation: Department of Ophthalmology, San Raffaele Scientific Institute, Milan, Italy.|Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Bandello
authors.affiliation: Department of Radiology, San Raffaele Scientific Institute - Vita Salute University, Via Olgettina, 60, 20132, Milan, Italy.|Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Del Maschio
mesh_terms: D020216:Carotid-Cavernous Sinus Fistula / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018615:Ultrasonography, Doppler, Color
keywords: Carotid-cavernous sinus fistula; Cerebral angiography; Color Doppler ultrasonography; Eye diseases; Ultrasonography