CT and MR imaging of non-cavernous cranial dural arteriovenous fistulas: Findings associated with cortical venous reflux

Abstract

PurposeTo compare the conventional CT and MR findings of DAVFs in relation to the venous drainage pattern on digital subtraction angiography (DSA). Materials and MethodsCross-sectional imaging findings (CT and/or MR) in 92 patients were compared to the presence of cortical venous reflux (CVR) on DSA. ResultsImaging features significantly more prevalent in patients with CVR included: abnormally dilated and tortuous leptomeningeal vessels (92% vs. 4%, p<0.001) or medullary vessels (69% vs. 0%, p<0.001), venous ectasias (45% vs. 0%, p<0.001) and focal vasogenic edema (38% vs. 0%, p<0.001). The following findings trended towards association but did not reach the p value established following Bonferroni correction: dilated external carotid artery branches (71% vs. 38%, p=0.005), cluster of vessels surrounding dural venous sinus (50% vs. 19%, p=0.009), presence of hemorrhage (33 vs. 12%, p=0.040), and parenchymal enhancement (21% vs. 0%, p=0.030). ConclusionIn the appropriate clinical setting, recognition of ancillary signs presumably related to venous arterialization and congestion as well as arterial feeder hypertrophy should prompt DSA confirmation to identify DAVFs associated with CVR.