Article Figures & Data
Figures
- Fig 1.
A 68-year-old woman with left cavenous sinus dural AVF.
A-C, Preoperative IADSAs (A and B) show a cavenous sinus dural AVF with early filling in the bilateral inferior petrosal sinus (IPS; arrowheads) and the dilated superior ophthalmic vein (SOV; arrow). C, Preoperative MRDSA (axial) shows early venous filling in the cavenous sinus (arrowhead), IPS (double arrowheads), and reflux into the sphenoparietal sinus (arrows) and SOV (double arrows).
D-F, After TVE, IADSAs (D and E) show a small residual shunt (arrowhead) in the cavenous sinus. F, Postoperative MRDSA is unable to detect this shunt.
- Fig 2.
A 69-year-old woman with a left sigmoid sinus dural AVF presenting with intracranial hemorrhaging.
A and B, Preoperative IADSAs show a sigmoid sinus dural AVF with aggressive leptomeningeal drainage (arrowheads). The main feeding artery is shown to be the occipital artery (arrow). C, Preoperative MRDSA (sagittal) shows early venous filling with a pseudophlebitic pattern (venous congestion; arrowheads). The main feeding artery is shown to be the occipital artery (arrow).
D and E, After TVE, IADSAs show the disappearance of the dural AVF. F, Postoperative MRDSA is unable to detect this shunt.
- Fig 3.
A 69-year-old man with left tentorial sinus dural AVF presenting with an intracranial hemorrhage.
A-C, Preoperative IADSAs (A and B) show a tentorial sinus dural AVF with varices (arrowheads). The main feeding artery is shown to be the tentrial artery (arrow). C, Preoperative MRDSA (axial) shows early venous filling (arrowhead) with varices (double arrowhead). The main feeding artery is shown to be the tentorial artery (arrow).
D-F, After TVE, IADSAs (D and E) show the disappearance of the dural AVF. F, Postoperative MRDSA shows no abnormal pattern.
Tables
Age (y) 64.3 ± 12.0 (37–88) Sex (M:F) 9:16 Presentation Asymptomatic 1 (4%) Tinnitus 8 (32%) Headache 3 (12%) Vertigo 1 (4%) Myelopathy 1 (4%) Chemosis 6 (24%) Diplopia 1 (4%) ICH 2 (8%) SAH 2 (8%) Location Cavenous 11 (44%) Sigmoid 9 (36%) Tent 2 (8%) Anterior condylar 1 (4%) Craniocervical 1 (4%) Spine 1 (4%) Treatment Observation 4 (16%) IVR (TAE) 1 (4%) IVR (TVE) 17 (68%) IVR/craniotomy 3 (12%) Follow-up (mo) 12.6 ± 11.4 (1–33) Note.—ICH indicates intracerebral hemorrhage; SAH, subarachnoid hemorrhage; IVR, interventional radiology; TAE, transarterial embolization; TVE, transvenous embolization.
Reviewer MRDSA IADSA Sensitivity (%) Specificity (%) Positive Predictive Value (%) Negative Predictive Value (%) Present Absent Present Absent Preoperative study Feeding arteries R1 3 21 23 1 13.0 100 100 4.8 R2 2 22 8.7 100 100 4.5 Early venous filling R1 24 0 23 1 100 —* 95.8 0/0 R2 24 0 100 —* 95.8 0/0 Sinus occlusion R1 1 23 1 23 100 100 100 100 R2 1 23 100 100 100 100 Leptomeningeal venous drainage R1 12 12 16 8 75.0 100 100 66.7 R2 14 10 87.5 100 100 80 Varices R1 5 19 5 19 100 100 100 100 R2 5 19 100 100 100 100 Pseudophrebitic pattern R1 3 21 3 21 100 100 100 100 R2 2 22 66.7 100 100 95.4 Postoperative and follow-up study Feeding arteries R1 0 22 3 19 0 100 100 13.6 R2 1 21 33.3 100 100 9.5 Early venous filling R1 6 16 6 16 100 100 100 100 R2 5 17 83.3 100 100 94.1 Sinus occlusion R1 0 22 0 22 100 100 100 100 R2 0 22 100 100 100 100 Leptomeningeal venous drainage R1 2 20 1 21 —* 90.4 0/2 95.0 R2 0 22 —* 100 100 95.4 Varices R1 0 22 0 22 100 100 100 100 R2 0 22 100 100 100 100 Pseudophrebitic pattern R1 0 22 0 22 100 100 100 100 R2 0 22 100 100 100 100 * Not calculated because of the small number. R1 indicates reviewer 1; R2, reviewer 2.
Note.—AVF indicates arteriovenous fistula; MRDSA, magnetic resonance digital subtraction angiography; IADSA, intraarterial digital subtraction angiography.
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