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AJNR - American Journal of Neuroradiology

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Doppler Sonographic Evaluation of Shunts in Patients with Dural Arteriovenous Fistulas

Stephan J. Schreiber^a, Rolf R. Diehl^c, Werner Weber^d, Hans Henkes^d, Hans C. Nahser^e, Rüdiger Lehmann^b, Florian Doepp^a and José M. Valdueza^a

^a Department of Neurology, Berlin, Germany
^b Department of Neuroradiology, Berlin, Germany
^c Department of Neurology, Essen, Germany
^d Department of and Neuroradiology, Essen, Germany
^e Department of Neuroradiology, Walton Centre for Neurology and Neurosurgery, Liverpool, UK

View larger version (166K): [in a new window]   FIG 1. Lateral angiogram with common carotid artery contrast material injection shows an occipital DAVF (patient 1). Inset, Image shows selective contrast material filling of the occipital artery. Note early venous filling of the IJV (arrows).

View larger version (125K): [in a new window]   FIG 2. Sample Doppler spectra during the arrival of the contrast-agent bolus in two patients. Intravenous injection occurred at 0 seconds. Color change of the Doppler spectrum from blue to orange (arrows) indicates arrival of the bolus. The superimposed transient, high-frequency signals that fill the complete frequency range of the Doppler are artifacts caused by echo contrast-induced overmodulation (blooming effect). White lines in each spectrum represent the computer-generated graph of the calculated peak intensity values of the spectrum. Top: Spectra in patient 9, who was untreated. Note the typical, pulsatile, flow signal intensity in the ICA and the arterialized flow in the IJV. Moderate jugular vein compression at 16–19 seconds leads to a marked reduction in signal intensity. Bottom: Spectra in patient 5 after incomplete occlusion of the malformation. Note the still-prevailing, arterialized flow and the two-step pattern of intensity rise in the IJV; the moderate increase in venous intensity increase between 14.5 and 20.2 seconds; and the second, sharp intensity rise at 20.2 seconds.

View larger version (45K): [in a new window]   FIG 3. Sample time-intensity curves and data analysis in a healthy control subject. Vertical gray lines are the raw data. Black and gray curves are polynomic fit, where gray indicates 80% of total signal-intensity increase, CCT = v0 – a0 = 7.3 seconds, where v0 and a0 = turning point of the venous and arterial polynomic fit. Venous rise time t = v2 – v1 = 8.2 seconds. Arterial rise time t = a2 – a1 = 4.2 seconds. a1 and v1 = point at 10% total intensity increase, and a2 and v2 = point at 90% total intensity increase.

View larger version (21K): [in a new window]   FIG 4. Box-plot analysis of the results, including the mean, median, 25/75 percentiles (box) and 5/95 percentiles (whisker). Top: Plots of CCT results in control subjects (n = 30) and patients with DAVF (n = 13). Dotted line represents the cutoff value of 3.3 seconds [mean CCTcontrols – (3 x SDcontrols)] chosen for sensitivity and specificity analysis. Bottom: Plots of venous t in control subjects and patients.