Posterior fossa dural arteriovenous fistulas: diagnosis and follow-up with time-resolved imaging of contrast kinetics (TRICKS) at 1.5T

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Time-of-flight MR angiography (TOF MRA) is currently the most widely used non-invasive imaging tool to diagnose dural arteriovenous fistula (DAVF). It is, however, not as sensitive as invasive digital subtraction angiography (DSA) for detecting the arteriovenous shunting inherent in DAVF. Dynamic contrast-enhanced MR angiography allows separation of arterial and venous phases of contrast passage though the brain and can thus demonstrate early venous filling through the arteriovenous shunt. To compare the diagnostic value of TOF MRA and a commercially available dynamic contrast-enhanced MR angiography sequence (TRICKS) at 1.5T in detecting posterior fossa DAVF. We retrospectively collected image data for 19 patients who underwent TOF MRA, TRICKS, and DSA either for primary diagnosis or for follow-up of posterior fossa DAVF and assessed the performance of TOF MRA and TRICKS in demonstrating the arteriovenous shunt, with DSA as the reference standard. TRICKS detected early arterial filling at 94.4% sensitivity and 83.3% specificity. TOF MRA detected high flow-related signal within venous structures at 64.7% sensitivity and 80% specificity. The commercially available dynamic MR angiography sequence TRICKS with fully automatic vendor postprocessing at 1.5T is more sensitive than TOF MRA in detecting the arteriovenous shunt in posterior fossa DAVF.