The Role of the Occipital Artery in the Diagnosis of Intracranial Dural Arteriovenous Fistula Using Duplex Sonography

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Fig. 1.
A 76-year-old man with dural arteriovenous fistula complicated by cerebellar hemorrhage. A, The DAVF (asterisk), located at cerebellar falx, was supplied mainly via the left occipital artery (OA, arrow). The sonographic image of OA is shown at the left upper panel. B, Duplex sonography reveals an abnormal decrease of the resistance index and an increase of the peak systolic velocity and end diastolic velocity in the left OA, while the hemodynamics in the left external carotid artery were unremarkable.

Table 1:

Patients with dural arteriovenous fistulas with and without an occipital artery as one of the feeders^{^a}

	Dural Arteriovenous Fistulas		P Value
	With OA (n = 92 )	Without OA (n = 89 )	P Value
Age (yr) (SD)	54 ± 14	56 ± 16	.19
Male (%)	44 (48)	29 (33)	.04
Location (%)
Cavernous sinus	3 (3)	60 (9)	<.001
Large sinuses^{^b}	60 (65)	9 (10)
Other sinuses^{^b}	29 (32)	20 (23)
Type (%)
I and IIa	34 (37)	53 (60)	<.001
IIb, IIa+b, and III	48 (52)	34 (38)
IV and V	10 (11)	2 (2)
Aggressiveness (%)	36 (39)	21 (24)	.03

↵a Values are numbers (percentages), except age.
↵b Large sinuses include the transverse, sigmoid, and superior sagittal sinuses; other sinuses include all locations other than the cavernous sinus and large sinuses.

Table 2:

Hemodynamics using duplex sonography in control subjects

Note:—EDV indicates end diastolic velocity (centimeters/second); PSV, peak systolic velocity (cm/s); RI, resistance index.

Table 3:

Hemodynamics in patients with DAVF and control subjects using duplex sonography

	DAVF (n = 24)	Control (n = 60)	P Value	Ratio^{^a}
OA
RI	0.49 ± 0.13	0.89 ± 0.07	<.001	0.53
PSV	119 ± 48	53 ± 19	<.001	2.9
EDV	64 ± 30	6 ± 4	<.001	14.6
ECA
RI	0.6 ± 0.09	0.86 ± 0.05	<.001	0.67
PSV	112 ± 31	70 ± 16	<.001	1.7
EDV	45 ± 17	10 ± 4	<.001	4.9
CCA
RI	0.62 ± 0.07	0.72 ± 0.06	<.001	0.86
PSV	93 ± 21	76 ± 15	.007	1.2
EDV	35 ± 12	22 ± 6	<.001	1.7

Note:—EDV indicates end diastolic velocity (cm/s); PSV, peak systolic velocity (cm/s); RI, resistance index.
↵a Ratio is the data collected from patients with DAVFs versus those of control subjects.

Table 4:

Diagnostic performances of duplex parameters for dural arteriovenous fistula

	Cutoff	Sensitivity	Specificity	PPV	NPV	Accuracy
OA
RI	0.76	0.96	0.97	0.92	0.98	0.96
PSV	92	0.67	0.88	0.70	0.87	0.82
EDV	14	0.96	0.95	0.88	0.98	0.95
ECA
RI	0.75	0.88	0.87	0.72	0.95	0.87
PSV	103	0.58	0.58	0.36	0.78	0.58
EDV	18	0.96	0.67	0.53	0.98	0.75
CCA
RI	0.59	0.29	0.98	0.88	0.78	0.79
PSV	107	0.25	0.87	0.43	0.74	0.69
EDV	33	0.50	0.95	0.80	0.83	0.82

Note:—EDV indicates end diastolic velocity (centimeters/second); NPV, negative predictive value; PPV, positive predictive value; PSV, peak systolic velocity (cm/s); RI, resistance index.