Dural Arteriovenous Fistulae: Noninvasive Diagnosis with Dynamic MR Digital Subtraction Angiography

We read with interest the article by Coley et al (1), in which the authors describe their early experience with an experimental dynamic MR angiographic method using a contrast agent and a digital mask for assessment of dural arteriovenous fistulae (AVF). It is well known from the literature (2, 3) that MR digital subtraction angiography is a noninvasive, dynamic tool for intracranial MR angiography.

It should be noted that the reference list in Coley et al’s article is incomplete. The statement, “we present the first report of its use in the detection and classification of dural AVF” is incorrect. Our article (2 describes the technique and promising results in the assessment of brain arteriovenous malformations and dural AVF.

This point of view is supported in an editorial published in the AJNR (4). Similar to an article by Griffiths et al (5) (see comments [6]) published in the AJNR, the case report by Coley et al overlaps substantially with previously published investigations (2, 3). Despite that a case report should present an important and unique clinical experience, the article by Coley et al must be classified as a redundant publication according to the principles of the HEART Group (7). When submitting a manuscript, authors should make a full statement to the editor regarding previous reports to avoid redundant publication according to these principles.

In addition, not to cite basic articles when reporting a technique for the first time is unscientific. The specificity and sensitivity of MR digital subtraction angiography to classify dural AVF has not been formally evaluated. On the basis of our experience, we think that MR digital subtraction angiographic techniques in their current forms are limited in the detection of small and low-flow fistulae that involve only cortical veins. Because dural AVF with cortical drainage are at risk for bleeding, MR digital subtraction angiography cannot currently replace conventional digital angiography with its high anatomic resolution.

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