The Role of Ferumoxytol-Enhanced MR Venography in Transvenous Embolization of CSF-Venous Fistulas

BACKGROUND AND PURPOSE: Spontaneous intracranial hypotension (SIH) often results from CSF-venous fistulas (CVFs), and transvenous embolization is an effective treatment. Precise preprocedural venous mapping is crucial to optimize outcomes and mitigate risks. The purpose of this study was to evaluate the utility of ferumoxytol-enhanced MRV in delineating venous anatomy for preprocedural planning in CVF treatment.

MATERIALS AND METHODS: This retrospective study included 57 participants referred for paraspinal venous embolization between July 2021 and February 2024. Participants were categorized into 3 groups: SIH with confirmed CVFs, SIH without identified CVFs, and behavioral variant frontotemporal dementia without CVFs. All participants underwent ferumoxytol-enhanced MRV to assess venous anatomy.

RESULTS: The cohort had mean age of 56.4 years (range, 18–86 years) and included 31 women and 26 men. Identified findings included a high prevalence of lumbar segmental veins draining directly into the inferior vena cava (93%), lumbar segmental veins draining into the left renal vein (54%), and incomplete ascending lumbar veins (63%). Other findings included a duplicated inferior vena cava (1.8%) and the pathologic condition azygos vein stenosis (7%). Preprocedural MRV effectively identified venous variations, guiding tailored intervention strategies, and minimizing procedural risks.

CONCLUSIONS: Ferumoxytol-enhanced MRV provides comprehensive venous mapping, facilitating safer and more efficient planning for CVF treatment.