Abstract
Identifying the precise hemodynamic features, including the fistulous point, is essential for treatments of dural arteriovenous fistulas (DAVFs). This study illustrates the efficacy of DynaCT digital angiograms obtained from a 3D C-arm CT to directly visualize the location of the fistulous points in DAVFs. This retrospective study observed 14 consecutive patients with DAVFs, which included 7 cavernous sinuses, 4 transverse-sigmoid sinuses, 2 convexity-superior sagittal sinuses, and 1 tentorial sinus. In the assessment of the practical applicability for the diagnosis of DAVFs, images obtained from 2D digital subtraction angiography (DSA) and DynaCT were comparatively evaluated. In all patients, DynaCT digital angiography could clearly demonstrate the feeding arteries, the fistulous points, and the draining veins. Significant anatomic landmarks for the fistulous points with relationships to osseous structures were also provided. Compared with 2D DSA, DynaCT digital angiograms demonstrated 12 additional findings in 8 patients (57%), including the detection of the fistulous points (n = 7), the feeders (n = 1), the retrograde leptomeningeal drainage (n = 1), the draining veins (n = 1), and the venous anomaly (n = 2). In comparison with 2D DSA, DynaCT may provide more detailed information to evaluate DAVFs. DynaCT digital angiograms have a high contrast and isotropic spatial resolution, allowing a reliable visualization of small vessels and fine osseous structures. Such detailed information, especially for the location of the fistulous points, could be very useful for either the endovascular or the surgical treatments of DAVFs.
Highlights
AND PURPOSE: Identifying the precise hemodynamic features, including the fistulous point, is essential for treatments of dural arteriovenous fistulas (DAVFs)
Compared with 2D digital subtraction angiography (DSA), DynaCT digital angiograms demonstrated 12 additional findings in 8 patients (57%), including the detection of the fistulous points (n ϭ 7), the feeders (n ϭ 1), the retrograde leptomeningeal drainage (n ϭ 1), the draining veins (n ϭ 1), and the venous anomaly (n ϭ 2)
The identification of the precise hemodynamic features with regard to the feeding arteries, the draining veins, and especially the location of the fistulous points is essential for the optimal treatments of DAVFs
Summary
This retrospective study observed 14 consecutive patients with DAVFs, which included 7 cavernous sinuses, 4 transverse-sigmoid sinuses, 2 convexity-superior sagittal sinuses, and 1 tentorial sinus. Between August 2006 and February 2008, a total of 14 consecutive patients (5 men and 9 women; age range, 58 – 86 years; mean [SD], 71.7 Ϯ 7.4 years) in this hospital were confirmed to have DAVFs. DAVFs included 7 cavernous sinuses (CSs), 4 transverse-sigmoid sinuses, 2 convexity-superior sagittal sinuses, and 1 tentorial sinus. 2D DSA was performed after catheterization of the common, external, and internal carotid arteries and catheterization of the dominant vertebral artery. The volumes of nonionic iodinated contrast agent (Iopamiron 300; Bayer HealthCare, France) and the injection rates were 14 mL and 2 mL/s, respectively, to the external carotid artery (ECA) and 19 mL and 3 mL/s, respectively, to the internal carotid artery (ICA). DynaCT images consisted of thin-section maximum intensity projections (MIPs)
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