CT Angiography and MR Angiography in the Evaluation of Carotid Cavernous Sinus Fistula Prior to Embolization: A Comparison of Techniques
Clayton Chi-Chang Chena,c,d,
Patricia Chuen-Tsuei Changb,
Cherng-Gueih Shye,
Wen-Shien Chena and
Hao-Chun Hunga
a Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan
b Department of Ophthalmology, Taichung Veterans General Hospital, Taichung, Taiwan
c Department of Radiological Technology, Central Taiwan University of Science and Technology, Taichung, Taiwan
d Department of Physical Therapy, Hungkuang University, Taichung, Taiwan
e Department of Radiology, Pingtung Christian Hospital, Pingtung, Taiwan
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FIG 1. Segmental division of the cavernous carotid artery (after Debrun et al [10]).
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FIG 2. Detectability of CCFs by location according to segmental division (SD) of the ICA, by using each technique. Panels A, B, and C show results for CTA, MRA, and DSA, respectively. Bars indicate percentage of images having detectability ratings of poor (hatched), moderate (stippled), or good (open). P values indicate statistical significance for comparisons between locations by using the  2 test, for each technique.
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FIG 3. Detectability of CCFs by using CTA, MRA, and DSA, by location according to segmental division (SD) of the ICA. Panels A, B, and C show results for fistulas found at SD 3, SD 4, and SD 5, respectively. Bars indicate percentage of images having detectability ratings of poor (hatched), moderate (stippled) or good (open). P values indicate statistical significance for comparisons between modalities by using the 2 test, for each location.
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FIG 4. SD 3, DSA = CTA > MRA. Left CCF with left SOV drainage.
Images were made by using CTA (panels A–C), MRA (panels D–F), and vertebral DSA (posterior-anterior view in panel H, lateral view in panel I) before embolization. The fistula ostium (panels B and E), proximal portion (panels A and D), and distal portion (panels C and F) are shown. A CTA source image made following embolization (panel G) shows the detachable balloon located at the previous fistula site. CS, cavernous sinus; DB, detachable balloon; F, fistula tract; SD, segmental division of the ICA.
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FIG 5. SD 3, DSA = CTA = MRA. Right CCF with transection of ICA.
Images were made by using CTA (panels A–C), MRA (panels D–F), and carotid DSA (lateral view, panel H) before embolization. The fistula ostium (panels B and E), proximal portion (panels A and D) and distal portion (panels C and F) are shown. Panel G shows an image made by using MIP reconstruction MRA. CS, cavernous sinus; F, fistula tract; MIP, maximal intensity projection; SD, segmental division of the ICA.
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