Intracranial Dural Arteriovenous Fistula with Retrograde Cortical Venous Drainage: Use of Susceptibility-Weighted Imaging in Combination with Dynamic Susceptibility Contrast Imaging

Abstract

SWI is a new MR imaging method that maximizes sensitivity to magnetic susceptibility effects with phase information for visualizing small cerebral veins. The purpose of this study was to report the use of SWI in combination with DSC in examining related RCVD in patients with intracranial DAVFs. Ten patients with angiographically confirmed DAVFs with RCVD underwent conventional MR imaging, SWI, and DSC. The ability of SWI to depict dilated cerebral veins was evaluated and then compared with DSC. The hemispheres of patients with DAVFs were grouped into affected (with RCVD) or nonaffected (without RCVD) categories by angiography. Four patients had bilaterally affected hemispheres. A total of 14 affected hemispheres in patients with DAVFs with RCVD were evaluated. SWI showed dilated cerebral veins on the surface of the brain in all (100%) of the 14 affected hemispheres in patients with DAVFs with RCVD and deep in the brain in 9 (64%). T2-weighted imaging showed prominent flow-voids on the surface of the brain in 10 (71%) of the 14 affected hemispheres in patients with DAVFs with RCVD and deep in the brain in 5 (36%). DSC showed increased cerebral blood volume in all of the 14 affected hemispheres. The SWI findings regarding dilated veins on the surface of the brain corresponded well with the areas of increased cerebral blood volume. SWI in combination with DSC could be used to characterize the presence of RCVD in patients with DAVFs.