CT Angiography as a Screening Tool for Dural Arteriovenous Fistula in Patients with Pulsatile Tinnitus: Feasibility and Test Characteristics

Abstract

BACKGROUND AND PURPOSE:The diagnosis of intracranial DAVF with noninvasive cross-sectional imaging such as CTA is challenging. We sought to determine the sensitivity and specificity of CTA compared with cerebral angiography for DAVF in patients presenting with PT.

Carotid CTA: Radiation Exposure and Image Quality with the Use of Attenuation-Based, Automated Kilovolt Selection

“…1 As the result of rapid technological evolution, the number of CT examinations is still rising, 2 even with the significant medical x-ray exposure 2,3 and the increasing awareness of the potential risks of even relatively low radiation doses 2,4 -especially in usage as a screening tool 5 or in serial use. 6 Biologic experiments have demonstrated that the number of DNA double-strand breaks is closely related to the applied dose.…”

Response to Letter Regarding Article, “Intracranial Dural Arteriovenous Fistulae: Clinical Presentation and Management Strategies”

“…However, the key factor determining management of DAVF remains the presence or the absence of CVD. On the basis of our review of the literature and current understanding of the natural history of aggressive DAVF, patients with fistula demonstrating CVD, even if they are asymptomatic, or do not have associated venous ectasia, should be offered treatment.In our review, we clearly state the limitations of the article by Narvid et al, 5 which evaluated the ability of computed tomography angiography to detect arterial feeders of DAVF. It is important to note that cross-sectional imaging techniques have made tremendous strides over the last several years, and they can be a reasonable screening study in low-risk patients (eg, those presenting with pulsatile tinnitus).…”

“…In our review, we clearly state the limitations of the article by Narvid et al, 5 which evaluated the ability of computed tomography angiography to detect arterial feeders of DAVF. It is important to note that cross-sectional imaging techniques have made tremendous strides over the last several years, and they can be a reasonable screening study in low-risk patients (eg, those presenting with pulsatile tinnitus).…”

Intracranial Dural Arteriovenous Fistulae

“…51,55-58 Narvid et al 58 evaluated CTA imaging of a small group of patients with known DAVF presenting with pulsatile tinnitus and found that the technique was both sensitive (86%) and specific (100%) for the detection of associated arterial feeders. Kwon et al 51 similarly evaluated the sensitivity of time-of-flight MRA for the detection of DAVF, and found that the technique had a sensitivity of 91% (n=11) for the detection of abnormal venous flow-related enhancement.…”

“…53,54 CT and MR angiography (CTA and MRA, respectively) may be used to screen patients suspected of harboring DAVF, grade or classify these lesions when detected, as well as evaluate for response to treatment (Figure 3). 51,[55][56][57][58] Both CTA and MRA may visualize the fistula itself as prominent vessels associated with the meninges or dural sinus wall, as well as detect enlarged feeding arteries, early dural sinus opacification, and prominent draining veins.…”