Intracranial Dural Arteriovenous Fistulas with Retrograde Cortical Venous Drainage: Assessment with Cerebral Blood Volume by Dynamic Susceptibility Contrast Magnetic Resonance Imaging
K. Noguchia,
M. Kubob,
N. Kuwayamab,
Y. Kamisakia,
G. Tomizawaa,
K. Kamedaa,
H. Kawabea,
S. Ogawaa,
N. Watanabea,
S. Endob and
H. Setoa
a Department of Radiology, Toyama University, Toyama, Japan
b Department of Neurosurgery, Toyama University, Toyama, Japan
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Fig 1. Schematic shows the region of interests for rCBV measurement on the target section.
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Fig 2. Dural arteriovenous fistula at left transverse-sigmoid sinus in a 52-year-old woman (case 7).
A, T2-weighted image shows no prominent flow voids on the cortical sulci.
B, Left external carotid angiogram depicts reflux in the vein of Labbe and retrograde cortical venous drainage with occlusion of left transverse sigmoid sinus.
C, Color overlay of relative cerebral blood volume (rCBV) map shows marked increase of CBV in the left hemisphere (mean rCBV ratio, 1.32).
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Fig 3. Dural arteriovenous fistula at superior sagittal sinus in a 70-year-old man (case 9).
A, T2-weighted image shows late subacute subcortical hematoma in the parietal lobe.
B, Venous phase of right common carotid angiogram depicts retrograde cortical venous drainage (RCVD) with occlusion of posterior part of superior sagittal sinus.
C, Venous phase of left common carotid angiogram also depicts RCVD with occlusion of posterior part of superior sagittal sinus.
D, Color overlay of relative cerebral blood volume (rCBV) map shows marked increase of CBV in the hemispheres bilaterally. The extent of increase of CBV is larger in the right hemisphere than in the left hemisphere (mean rCBV ratio, 1.37; however, the rCBV ratio may be underestimated because of the bilateral affected hemispheres).
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Fig 4. Box and whisker plot show mean relative cerebral blood volume (rCBV) ratio in control subjects and in patients with dural arteriovenous fistulas (DAVF) with retrograde cortical venous drainage (RCVD). The mean rCBV ratio in patients with DAVF with RCVD is significantly higher than that in control subjects (P = .0002).
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Fig 5. Dural arteriovenous fistula in left transverse-sigmoid sinus in a 71-year-old man (case 2).
A, Color overlay of relative cerebral blood volume (rCBV) map shows marked increase of CBV in the left hemisphere (mean rCBV ratio, 1.94).
B, Color overlay of rCBV map obtained after partial embolization shows improvement of increase of CBV in the left hemisphere (mean rCBV ratio, 1.74).
C, Color overlay of rCBV map obtained after surgical operation (direct packing of the venous sinus) shows more improvement of increase of CBV in the left hemisphere (mean rCBV ratio, 1.23).
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