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Research ArticleBrain

Detection and Classification of Cranial Dural Arteriovenous Fistulas Using 4D-CT Angiography: Initial Experience

P.W.A. Willems, P.A. Brouwer, J.J. Barfett, K.G. terBrugge and T. Krings
American Journal of Neuroradiology January 2011, 32 (1) 49-53; DOI: https://doi.org/10.3174/ajnr.A2248
P.W.A. Willems
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P.A. Brouwer
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J.J. Barfett
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K.G. terBrugge
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T. Krings
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Abstract

BACKGROUND AND PURPOSE: The criterion standard to diagnose and classify cranial DAVFs is DSA. Since this is invasive, relatively expensive and time-consuming, a noninvasive alternative is of interest. We aimed to evaluate the capabilities and pitfalls of 4D-CTA in a consecutive series of patients who presented with a newly diagnosed cranial DAVF, as demonstrated by conventional DSA.

MATERIALS AND METHODS: Eleven patients were included in this study after biplane DSA demonstrated a cranial DAVF. They subsequently underwent 4D-CTA imaging by using a 320-detector CT scanner. DSA and 4D-CTA studies were independently read by 2 blinded observers, by using a standardized scoring sheet. 4D-CTA results were analyzed with DSA as the criterion standard.

RESULTS: In 10 cases, there was full agreement between DSA and 4D-CTA regarding the Borden classification. However, in the remaining patient, a slow-filling DAVF with a low shunt volume was missed by both readers on 4D-CTA. In all 10 detected cases, ≥1 of the major contributing arteries could be identified with 4D-CTA. Although, by using DSA, the 2 observers identified additional arterial feeders in 7 and 8 cases, respectively, these discrepancies did not influence clinical decision making.

CONCLUSIONS: Although novel 4D-CTA imaging may not rule out a small slow-flow DAVF, it appears to be a valuable new adjunct in the noninvasive diagnostic work-up, treatment planning, and follow-up of patients with cranial DAVFs.

Abbreviations

CTA
CT angiography
DAVF
dural arteriovenous fistula
4D-CTA
4D (time-resolved) CTA
DSA
digital subtraction angiography
ECA
external carotid artery
ICA
internal carotid artery
IV
intravenous
MRA
MR angiography
trMRA
time-resolved MRA
VA
vertebral artery
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American Journal of Neuroradiology: 32 (1)
American Journal of Neuroradiology
Vol. 32, Issue 1
1 Jan 2011
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Detection and Classification of Cranial Dural Arteriovenous Fistulas Using 4D-CT Angiography: Initial Experience
P.W.A. Willems, P.A. Brouwer, J.J. Barfett, K.G. terBrugge, T. Krings
American Journal of Neuroradiology Jan 2011, 32 (1) 49-53; DOI: 10.3174/ajnr.A2248

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Detection and Classification of Cranial Dural Arteriovenous Fistulas Using 4D-CT Angiography: Initial Experience
P.W.A. Willems, P.A. Brouwer, J.J. Barfett, K.G. terBrugge, T. Krings
American Journal of Neuroradiology Jan 2011, 32 (1) 49-53; DOI: 10.3174/ajnr.A2248
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  • Engorged medullary vein on CT angiography in patients with dural arteriovenous fistula: prevalence, types, and comparison between regional and extensive types
  • 4D DSA for Dynamic Visualization of Cerebral Vasculature: A Single-Center Experience in 26 Cases
  • The application of susceptibility-weighted MRI in pre-interventional evaluation of intracranial dural arteriovenous fistulas
  • Use of Phase-Contrast MRA to Assess Intracranial Venous Sinus Resistance to Drainage in Healthy Individuals
  • Radiation Dose Reduction in 4D Cerebral CT Angiography by Individualized Estimation of Cerebral Circulation Time
  • Intracranial Dural Arteriovenous Fistulae: Clinical Presentation and Management Strategies
  • 4D-CTA in Neurovascular Disease: A Review
  • Evaluation of cerebral arteriovenous malformation using 'dual vessel fusion' technology
  • Simultaneous Arteriovenous Shunting and Venous Congestion Identification in Dural Arteriovenous Fistulas Using Susceptibility-Weighted Imaging: Initial Experience
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