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

BACKGROUND: Spontaneous intracranial hypotension (SIH) often results from cerebrospinal fluid-venous fistulas (CVFs), and transvenous embolization is an effective treatment. Precise preprocedural venous mapping is crucial to optimize outcomes and mitigate risks.

PURPOSE: To evaluate the utility of Ferumoxytol-enhanced MR venography (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 three groups: SIH with confirmed CVFs, SIH without identified CVFs, and behavioral variant frontotemporal dementia (bvFTD) 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 pathological 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.

ABBREVIATIONS: bvFTD = behavioral variant frontotemporal dementia; CTM = CT myelography; CVF(s) = cerebrospinal fluid-venous fistula(s); DSM = digital subtraction myelography; FS = fat saturated; SIH = spontaneous intracranial hypotension; VIBE = volumetric interpolated breath-hold.