Tortuous, Engorged Pial Veins in Intracranial Dural Arteriovenous Fistulas: Correlations with Presentation, Location, and MR Findings in 122 Patients
Robert Willinsky
,a,
Mayank Goyala,
Karel terBruggea and
Walter Montaneraa
a From the Department of Medical Imaging, The Toronto Hospital, Western Division, 399 Bathurst St, Toronto, Ontario, Canada M5T 2S8.
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FIG 1. Representative cases showing severity of PPP.
A–C, Examples of mild (A), moderate (B), and severe (C) PPP on lateral views of the venous phase of cerebral angiogram. Mild PPP has small tortuous collateral veins (short wide arrows, A and B) with slight irregularity of the cortical veins (long thin arrows, A and B). These changes are more evident in moderate PPP and more dramatic in severe PPP.
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FIG 2. 60-year-old woman with dementia.
A, Axial T2-weighted MR image shows hydrocephalus and a plethora of prominent subarachnoid vessels (arrows).
B and C, Lateral views of the arterial (B) and venous (C) phases of left occipital angiogram show a complex DAVF involving the distal transverse sinus with retrograde flow in an anomalous parietal dural venous sinus (arrow, B) and RLVD (arrows, C).
D, Lateral view of the venous phase of right internal carotid angiogram shows severe PPP.
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FIG 3. 51-year-old man with dementia after removal of an acoustic neuroma.
A, Lateral view of a right occipital angiogram shows a DAVF involving an occluded right transverse sinus with retrograde flow in the superior sagittal sinus (open arrow) and RLVD (solid arrows) into the straight sinus and basal vein of Rosenthal.
B and C, Lateral views of venous phase of left internal carotid angiograms done before (B) and 4 years after (C) treatment show less marked PPP at follow-up, consistent with clinical improvement.
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FIG 4. Age distribution of 130 patients with intracranial DAVF
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