Subcortical Calcification on CT in Dural Arteriovenous Fistula with Cortical Venous Reflux
T. Metokia,
S. Mugikuraa,
S. Higanoa,
M. Ezurab,
Y. Matsumotod,
K. Hirayamac and
S. Takahashia
a Departments of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
b Neuroendovascular Therapy, Tohoku University Graduate School of Medicine, Sendai, Japan
c Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan
d Department of Neuroendovascular Therapy, Kohnan Hospital, Sendai, Japan
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Fig 1. Case 1.
A, Precontrast CT scan shows curvilinear calcification (arrowhead) in the cortico-medullary junction at the inferior part of the left temporal lobe.
B, Postcontrast T1-weighted image shows multiple foci of curvilinear enhancement along the gyri, indicating dilated venous channels due to reflux (arrowheads).
C, Lateral view of left external carotid angiogram shows dAVF at left transverse sinus fed by the middle meningeal artery (arrow) and cortical venous reflux (arrowhead).
D, SPECT shows markedly reduced blood flow in the left temporal lobe where the cortical venous reflux was found.
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Fig 2. Case 2.
A, CT scan shows curvilinear calcification in the cortico-medullary junction at the bottom of cerebral sulci bilaterally but more predominantly in right cerebral hemisphere.
B, T2-weighted MR image shows prominent cortical and subependymal veins (arrowheads), which possibly suggests an arteriovenous shunt with cortical venous reflux as well as hyperintensity in deep white matter that was more apparent on the right.
C–E, Serial right external carotid angiograms (C and D, lateral view; E, frontal view) show enlargement of the middle meningeal artery with early filling of the transverse sinus and retrograde filling of the straight and superior sagittal sinuses. Cortical venous reflux is also evident in the later phase.
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Fig 3. Case 3.
A, CT scans shows diffuse atrophy and subtle calcification in the basal ganglia and subcortical region at the bottom of cerebral gyri bilaterally. The subcortical calcification was curvilinear and predominant on the right side.
B–E, Right external carotid angiograms (B–D, lateral projection; E, frontal projection) show dAVF fed by the enlarged middle meningeal (arrow) and ascending pharyngeal arteries with cortical venous reflux (arrowheads).
F, Repeated CT scans after 1 year reveal a more advanced degree of diffuse atrophy and denser subcortical calcification.
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