Skip to main content
Advertisement

Main menu

  • Home
  • Content
    • Current Issue
    • Publication Preview--Ahead of Print
    • Past Issue Archive
    • Case of the Week Archive
    • Classic Case Archive
    • Case of the Month Archive
    • COVID-19 Content and Resources
  • For Authors
  • About Us
    • About AJNR
    • Editors
    • American Society of Neuroradiology
  • Submit a Manuscript
  • Podcasts
    • Subscribe on iTunes
    • Subscribe on Stitcher
  • More
    • Subscribers
    • Permissions
    • Advertisers
    • Alerts
    • Feedback
  • Other Publications
    • ajnr

User menu

  • Subscribe
  • Alerts
  • Log in

Search

  • Advanced search
American Journal of Neuroradiology
American Journal of Neuroradiology

American Journal of Neuroradiology

  • Subscribe
  • Alerts
  • Log in

Advanced Search

  • Home
  • Content
    • Current Issue
    • Publication Preview--Ahead of Print
    • Past Issue Archive
    • Case of the Week Archive
    • Classic Case Archive
    • Case of the Month Archive
    • COVID-19 Content and Resources
  • For Authors
  • About Us
    • About AJNR
    • Editors
    • American Society of Neuroradiology
  • Submit a Manuscript
  • Podcasts
    • Subscribe on iTunes
    • Subscribe on Stitcher
  • More
    • Subscribers
    • Permissions
    • Advertisers
    • Alerts
    • Feedback
  • Follow AJNR on Twitter
  • Visit AJNR on Facebook
  • Follow AJNR on Instagram
  • Join AJNR on LinkedIn
  • RSS Feeds
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
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
P.A. Brouwer
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
J.J. Barfett
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
K.G. terBrugge
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
T. Krings
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
  • References
  • PDF
Loading

Article Figures & Data

Figures

  • Tables
  • Fig 1.
    • Download figure
    • Open in new tab
    • Download powerpoint
    Fig 1.

    Imaging of a 65-year-old man who presented with an intracranial hemorrhage and whose DAVF was missed by 4D-CTA. A, Nonenhanced cranial CT scan on admission demonstrates the presenting hemorrhage. B, DSA, lateral view after left ECA injection, demonstrates abnormal retrograde filling of a pial vein (arrow), indicative of a DAVF. C, Lateral view of 4D-CTA, maximum intensity projection of the early venous phase, shows the same pial vein (arrow). Because visualization of the pial veins is expected on global opacification, only early filling would indicate a DAVF. However, due to the slow flow through the fistula, early venous filling could not be identified. Hence, this 4D-CTA study was read as having normal findings.

  • Fig 2.
    • Download figure
    • Open in new tab
    • Download powerpoint
    Fig 2.

    Imaging of a 60-year-old woman who presented with a right-sided pulse-synchronous tinnitus. A, DSA, lateral view after right ECA injection, demonstrates a DAVF (Borden I and Cognard I) at the level of the left sigmoid sinus (large arrow). The lesion is fed through a small arterial network (small arrow), which is mainly supplied by a branch from the occipital artery (large arrowhead) and to a lesser degree by a branch from the middle meningeal artery (small arrowhead). B, Lateral view of 4D-CTA, maximum intensity projection of late arterial phase, shows the early venous drainage into the right sigmoid sinus (large arrow). Compared with the DSA, the 4D-CTA is in agreement with regard to the site and classification of the lesion, as well as to its dominant feeder from the occipital artery (large arrowhead). However, although the smaller feeder from the middle meningeal artery can be seen (small arrowhead), neither reader had recorded it as such The small arrow indicates the arterial network feeding the fistula.

  • Fig 3.
    • Download figure
    • Open in new tab
    • Download powerpoint
    Fig 3.

    Imaging of a 47-year-old man who presented with a pulse-synchronous occipital bruit. A, DSA, lateral view after selective injection of the left occipital artery, demonstrates an extensive fistula at the torcular and left transverse sinus with cortical venous reflux (arrows). B, The later phase of the same injection demonstrates additional retrograde sinusoidal flow into the superior sagittal sinus (arrow). It was scored as Cognard grade IIa+b, due to both sinusoidal and pial reflux. C, Lateral view of 4D-CTA, maximum intensity projection of late arterial phase, shows early venous filling with cortical venous reflux (arrows). D, The venous phase of the same 4D-CTA study shows filling of the superior sagittal sinus, which is presumed to be antegrade. Because vascular opacification is nonselective, the temporal resolution is insufficient to recognize retrograde superior sagittal sinus filling. Thus, on the basis of this study, the lesion was erroneously scored as Cognard grade IIb.

Tables

  • Figures
    • View popup
    Table 1:

    Items scored by each reader for both DSA and 4D-CTA images

    ItemOptions
    DAVF detectedYes/no
    Classification of Borden et al5
        IDrains through dural sinus
        IIRetrograde flow from sinus into cortical veins
        IIIDirect flow into cortical veins
    Classification of Cognard et al1
        IAntegrade sinusoidal flow
        IIReflux: a) sinusoidal, b) arachnoid or both
        IIIDirect flow into cortical veins
        IVSame as III, but with venous ectasias
        VFlow into perimedullary veins
    Arterial feeders, large
    ECA
    ICA
    VA
    Any combination of the above
    Arterial feeders, small
    ECA: Occipital artery, auricular artery, superficial temporal artery, middle meningeal artery, ascending pharyngeal artery, internal maxillary artery
    ICA: Posterior group, inferolateral trunk, meningohypophyseal trunk, ophthalmic system
    VA: Muscular/occipital branches, posterior meningeal artery, posterior inferior cerebellar artery
    Any combination of the above
    Fistula typeSingle hole (focal)/multihole (diffuse)
    Venous outflow obstructionYes/no
    Isolated/trapped sinusYes/no
    • View popup
    Table 2:

    The frequencies of presenting symptoms according to the type of venous drainage, using the classification of Borden et al,5 as demonstrated with DSA

    Borden TypePresenting Symptoms
    IncidentalTinnitusHemorrhage
    I030
    II021
    III113
PreviousNext
Back to top

In this issue

American Journal of Neuroradiology: 32 (1)
American Journal of Neuroradiology
Vol. 32, Issue 1
1 Jan 2011
  • Table of Contents
  • Index by author
Advertisement
Print
Download PDF
Email Article

Thank you for your interest in spreading the word on American Journal of Neuroradiology.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Detection and Classification of Cranial Dural Arteriovenous Fistulas Using 4D-CT Angiography: Initial Experience
(Your Name) has sent you a message from American Journal of Neuroradiology
(Your Name) thought you would like to see the American Journal of Neuroradiology web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
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

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
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
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One
Purchase

Jump to section

  • Article
    • Abstract
    • Abbreviations
    • Materials and Methods
    • Results
    • Discussion
    • Conclusions
    • Acknowledgments
    • References
  • Figures & Data
  • Info & Metrics
  • References
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • 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
  • Crossref
  • Google Scholar

This article has not yet been cited by articles in journals that are participating in Crossref Cited-by Linking.

More in this TOC Section

  • Enhanced Axonal Metabolism during Early Natalizumab Treatment in Relapsing-Remitting Multiple Sclerosis
  • SWI or T2*: Which MRI Sequence to Use in the Detection of Cerebral Microbleeds? The Karolinska Imaging Dementia Study
  • Progression of Microstructural Damage in Spinocerebellar Ataxia Type 2: A Longitudinal DTI Study
Show more BRAIN

Similar Articles

Advertisement

News and Updates

  • Lucien Levy Best Research Article Award
  • Thanks to our 2022 Distinguished Reviewers
  • Press Releases

Resources

  • Evidence-Based Medicine Level Guide
  • How to Participate in a Tweet Chat
  • AJNR Podcast Archive
  • Ideas for Publicizing Your Research
  • Librarian Resources
  • Terms and Conditions

Opportunities

  • Share Your Art in Perspectives
  • Get Peer Review Credit from Publons
  • Moderate a Tweet Chat

American Society of Neuroradiology

  • Neurographics
  • ASNR Annual Meeting
  • Fellowship Portal
  • Position Statements

© 2023 by the American Society of Neuroradiology | Print ISSN: 0195-6108 Online ISSN: 1936-959X

Powered by HighWire