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Research ArticleHead and Neck Imaging

CT Angiography as a Screening Tool for Dural Arteriovenous Fistula in Patients with Pulsatile Tinnitus: Feasibility and Test Characteristics

J. Narvid, H.M. Do, N.H. Blevins and N.J. Fischbein
American Journal of Neuroradiology March 2011, 32 (3) 446-453; DOI: https://doi.org/10.3174/ajnr.A2328
J. Narvid
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H.M. Do
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N.H. Blevins
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N.J. Fischbein
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Abstract

BACKGROUND AND PURPOSE: The diagnosis of intracranial DAVF with noninvasive cross-sectional imaging such as CTA is challenging. We sought to determine the sensitivity and specificity of CTA compared with cerebral angiography for DAVF in patients presenting with PT.

MATERIALS AND METHODS: Following approval of the institutional review board, we reviewed all patients who underwent CTA for PT from 2004 to 2009 and collected clinical and imaging data. Seven patients with PT and proved DAVF and 7 age- and sex-matched control patients with PT but no DAVF composed the study group. CTA images were blindly interpreted by 2 experienced neuroradiologists for the presence of 5 variables: asymmetric arterial feeding vessels, “shaggy” appearance of a dural venous sinus, transcalvarial venous channels, asymmetric venous collaterals, and abnormal size and number of cortical veins. Asymmetric attenuation of jugular veins was additionally assessed.

RESULTS: The presence of arterial feeders showed good test characteristics for screening, with a sensitivity of 86% (95% CI, 42–99) and a specificity of 100% (95% CI, 52–100). A shaggy sinus or tentorium was highly specific: sensitivity of 42% (95% CI, 11–79) and specificity of 100% (95% CI, 56–100). The presence of transcalvarial venous channels demonstrated a poor sensitivity of 29% (95% CI, 5–70) but a high specificity 86% (95% CI, 42–99). CT attenuation of the jugular veins showed statistically significant asymmetry in the DAVF group versus the control group (P < .05).

CONCLUSIONS: CTA can be used to screen for DAVF in patients with PT. The presence of asymmetrically visible and enlarged arterial feeding vessels has a high sensitivity and specificity for the diagnosis of DAVF.

Abbreviations

APA
ascending pharyngeal artery
CI
confidence interval
CTA
CT angiography
CTV
CT venography
DAVF
dural arteriovenous fistula
DSA
digital subtraction angiography
dx
diagnosis
IJV
internal jugular vein
L
left
MHT
meningohypophyseal trunk
MIP
maximum intensity projection
MM
middle meningeal artery
MRA
MR angiography
MRV
MR venography
NPV
negative predictive value
Occ
occipital artery
PAur
posterior auricular artery
PCA
posterior communicating artery
PPV
positive predictive value
PT
pulsatile tinnitus
R
right
Vert
vertebral artery
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American Journal of Neuroradiology: 32 (3)
American Journal of Neuroradiology
Vol. 32, Issue 3
1 Mar 2011
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Cite this article
J. Narvid, H.M. Do, N.H. Blevins, N.J. Fischbein
CT Angiography as a Screening Tool for Dural Arteriovenous Fistula in Patients with Pulsatile Tinnitus: Feasibility and Test Characteristics
American Journal of Neuroradiology Mar 2011, 32 (3) 446-453; DOI: 10.3174/ajnr.A2328

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CT Angiography as a Screening Tool for Dural Arteriovenous Fistula in Patients with Pulsatile Tinnitus: Feasibility and Test Characteristics
J. Narvid, H.M. Do, N.H. Blevins, N.J. Fischbein
American Journal of Neuroradiology Mar 2011, 32 (3) 446-453; DOI: 10.3174/ajnr.A2328
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