Imaging diagnosis of carotid cavernous fistula

Abstract

To evaluate the value of ultrasonography, CT, MRI and digital subtraction angiography (DSA) in the diagnosis of carotid cavernous fistula (CCF). Twenty-eight cases of CCF patients were examined with ophthalmologic A/B echography and DSA, part of them were examined by one or several items among color Doppler imaging, CT and MRI. Ultrasonography could determine the enlarged ophthalmic vein with signal of blood stream and could detect the pulsation synchronizing with the pulse. CT and MRI could display the enlargement and abnormality of cavernous sinus. DSA could reveal fistulas supplied by internal carotid artery directly or by the dual branches of the carotid artery. The latter included meningohypophyseal trunk, capsular artery, middle meningeal artery, accessory meningeal artery, ascending pharyngeal artery and the artery of the foramen rotundum, etc. The drainage pathway of fistula included ophthalmic vein, inferior petrosal sinus, intercavernous sinus, sylvian vein and cortical drainage, etc. Each method of examination has its own advantages, combining of various methods can lead to an accurate diagnosis of CCF. DSA is the "golden standard" which can display supplying artery and the drainage pathway.