Sarah Toledano-Massiah1, Neesmah Badat2, Camille Ghorra2, Ahmad Sayadi2, Raphael Blanc3, Sophie Gerber2, Marc Zins2, Xavier Leclerc4, Jérôme Hodel5. 1. Department of Radiology, Fondation Hôpital Saint-Joseph, Paris, France. stoledano@hpsj.fr. 2. Department of Radiology, Fondation Hôpital Saint-Joseph, Paris, France. 3. Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France. 4. Departement of Neuroradiology, Roger Salengro Hospital, Lille, France. 5. Department of Neuroradiology, Centre Hospitalier-Universitaire Henri Mondor, Creteil, France.
Abstract
PURPOSE: Previous studies have shown that arterial spin-labeling (ASL) has high sensitivity and specificity for detecting dural arteriovenous fistulas (DAVFs). However, in case of jugular venous reflux (JVR), the labeled protons in the jugular vein may lead to a venous hypersignal in the jugular vein, sigmoid, and transverse sinus on ASL images and mimic DAVF. METHODS: To ascertain this hypothesis, two blinded senior neuroradiologists independently and retrospectively reviewed randomized ASL images and graded the likelihood of DAVF on a 5-point Likert scale in 2 groups of patients: (i) 13 patients with angiographically proven type I DAVF; and (ii) 11 patients with typical JVR diagnosed on the basis of clinical and MR imaging data, first using ASL alone, and second using ASL together with all of the sequences including 4D CE MRA. RESULT: A dural venous ASL signal was seen in 11 patients with type I DAVF and in all the 11 patients with JVR, with no distinctive pattern between the two. The mean Likert score was "very likely" in DAVF and JVR patients when using ASL alone (k = 0.71), and "very unlikely" for JVR versus "very likely" for DAVF when using all the sequences available (k = 0.92). CONCLUSION: Our study shows that JVR can mimic DAVF on ASL images with potential implications for patient care. The detection of DAVFs should be based on additional MR sequences such as TOF-MRA and 4D CE MRA to exclude JVR and to avoid unnecessary DSAs.
PURPOSE: Previous studies have shown that arterial spin-labeling (ASL) has high sensitivity and specificity for detecting dural arteriovenous fistulas (DAVFs). However, in case of jugular venous reflux (JVR), the labeled protons in the jugular vein may lead to a venous hypersignal in the jugular vein, sigmoid, and transverse sinus on ASL images and mimic DAVF. METHODS: To ascertain this hypothesis, two blinded senior neuroradiologists independently and retrospectively reviewed randomized ASL images and graded the likelihood of DAVF on a 5-point Likert scale in 2 groups of patients: (i) 13 patients with angiographically proven type I DAVF; and (ii) 11 patients with typical JVR diagnosed on the basis of clinical and MR imaging data, first using ASL alone, and second using ASL together with all of the sequences including 4D CE MRA. RESULT: A dural venous ASL signal was seen in 11 patients with type I DAVF and in all the 11 patients with JVR, with no distinctive pattern between the two. The mean Likert score was "very likely" in DAVF and JVR patients when using ASL alone (k = 0.71), and "very unlikely" for JVR versus "very likely" for DAVF when using all the sequences available (k = 0.92). CONCLUSION: Our study shows that JVR can mimic DAVF on ASL images with potential implications for patient care. The detection of DAVFs should be based on additional MR sequences such as TOF-MRA and 4D CE MRA to exclude JVR and to avoid unnecessary DSAs.
Entities:
Keywords:
Arteriovenous fistula; Cerebral blood flow; Cranial venous sinuses; Magnetic resonance angiography; Magnetic resonance imaging
Authors: M Travis Caton; Andrew L Callen; Alexander Z Copelan; Kazim H Narsinh; Eric R Smith; Matthew R Amans Journal: AJR Am J Roentgenol Date: 2020-09-02 Impact factor: 3.959