PT  - JOURNAL ARTICLE
AU  - Willems, P.W.A.
AU  - Brouwer, P.A.
AU  - Barfett, J.J.
AU  - terBrugge, K.G.
AU  - Krings, T.
TI  - Detection and Classification of Cranial Dural Arteriovenous Fistulas Using 4D-CT Angiography: Initial Experience
AID  - 10.3174/ajnr.A2248
DP  - 2011 Jan 01
TA  - American Journal of Neuroradiology
PG  - 49--53
VI  - 32
IP  - 1
4099  - http://www.ajnr.org/content/32/1/49.short
4100  - http://www.ajnr.org/content/32/1/49.full
SO  - Am. J. Neuroradiol.2011 Jan 01; 32
AB  - 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. CTACT angiographyDAVFdural arteriovenous fistula4D-CTA4D (time-resolved) CTADSAdigital subtraction angiographyECAexternal carotid arteryICAinternal carotid arteryIVintravenousMRAMR angiographytrMRAtime-resolved MRAVAvertebral artery