Differentiation of dural arteriovenous fistula from reflux venous flow on 3D TOF-MR angiography: identifying asymmetric enlargement of external carotid artery branches

Lee, J.; Lee, J.Y.; Lee, Y.-J.; Park, D.W.; Kim, T.Y.; Kim, Y.S.; Kim, H.Y.

doi:10.1016/j.crad.2020.05.016

Cited by 5 publications

(9 citation statements)

References 20 publications

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“…An ROC analysis demonstrated an AUC of 0.8341 with a difference as small as 0.3 mm between dilated and non-dilated MMA, allowing differentiation between patients with and without the lesion with 91.4% sensitivity and 77.1% specificity. These findings are comparable to those reported in a recent study by Lee et al, 15 which found that 14 of 17 MMA-fed lesions showed enlarged MMAs. The overall agreement between readers in identifying the dilated MMA sign was very good (j ¼ 0.878), slightly better than the previously reported value in a similar study by Azuma et al 14 (j ¼ 0.711), which assessed the main arterial feeders on 3D TOF MRA.…”

Section: Discussionsupporting

confidence: 92%

“…These were further stratified by location, with transverse-sigmoid and petrous locations being the two most common locations in our cohort. The study by Lee et al 15 (n ¼ 19) is the only other study documenting asymmetric enlargement of other feeders, namely the branches of the ECA, on 3D TOF MRA. Lee et al pre-determined the branches of the ECA i.e., the ascending pharyngeal artery, middle meningeal artery, accessory meningeal artery, artery of the foramen rotundum, and the occipital artery) to be analyzed.…”

Section: Discussionmentioning

confidence: 97%

“…A few published studies have proven the efficacy of 3D TOF MRA in the detection of cDAVFs. 14 , 15 Various features of vascular imaging have been described, including flow signal in the draining veins, angioarchitecture of the fistulous connection, asymmetry and enlargement of feeder arteries, 18 and demonstration of cortical venous reflux. Other techniques have also shown good sensitivity and specificity, 13 , 18 although they have drawbacks.…”

Section: Discussionmentioning

confidence: 99%

“…[11][12][13][14] In addition to identification of the fistulous connection, asymmetric enlargement of feeder vessels, which typically arise from the branches of the external carotid artery (ECA), has been reported as a feature for the detection of a possible cDAVFs. 15 Being the most extensive dural feeder, the middle meningeal artery (MMA) is the most commonly involved feeding artery for cDAVFs 15,16 and is frequently used as a pathway for transarterial embolization of cDAVF. 17 We conducted a retrospective analysis of all cDAVFs treated at our institution that were investigated with both 3D TOF MRA and digital subtraction angiography (DSA) to assess the accuracy of the asymmetrically enlarged MMA, which we termed as the "dilated MMA" sign, in the diagnosis of cDAVFs.…”

Section: Introductionmentioning

confidence: 99%

“…11 – 14 In addition to identification of the fistulous connection, asymmetric enlargement of feeder vessels, which typically arise from the branches of the external carotid artery (ECA), has been reported as a feature for the detection of a possible cDAVFs. 15 Being the most extensive dural feeder, the middle meningeal artery (MMA) is the most commonly involved feeding artery for cDAVFs 15 , 16 and is frequently used as a pathway for transarterial embolization of cDAVF. 17 …”

Section: Introductionmentioning

confidence: 99%

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Dilated MMA sign in cDAVF and other arterial feeders on 3D TOF MRA

Foo¹,

Swaminathan²,

Krings

2021

Neuroradiol J

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Background Among the varied causes of pulsatile tinnitus, the condition that can cause severe mortality and morbidity is a cranial dural arteriovenous fistula (cDAVF). This study aimed to assess the diagnostic accuracy of the dilated middle meningeal artery on three-dimensional time-of-flight magnetic resonance angiography in cranial dural arteriovenous fistula and to identify other feeders that can aid in the detection of these lesions. Method Magnetic resonance angiography and digital subtraction angiography data of all patients with cranial dural arteriovenous fistula treated in a single tertiary referral center between 2007–2020 were included. The middle meningeal artery and other feeders recorded from digital subtraction angiography were assessed on magnetic resonance angiography. Results The overall agreement between readers in identifying the dilated middle meningeal artery was substantial (κ = 0.878, 95% confidence interval: 0.775–0.982). The dilated middle meningeal artery indicated the presence of a cranial dural arteriovenous fistula with a sensitivity of 79.49% (95% confidence interval: 66.81–92.16), specificity of 100% (95% confidence interval: 100.00–100.00), and negative predictive value of 94.56% (95% confidence interval: 90.89–98.02). An area under the curve of 0.8341 was observed for the ipsilateral middle meningeal artery, with a sensitivity of 92.2% and a specificity of 75.0% at a cut-off of 0.30 mm for identifying a cranial dural arteriovenous fistula. Of 73 other feeders, the occipital, meningohypophyseal trunk, ascending pharyngeal, and posterior meningeal arteries contributed to a large proportion visualized on magnetic resonance angiography (83.6% (41/49)). Conclusion The dilated middle meningeal artery sign is useful for identifying a cranial dural arteriovenous fistula. Dilatation of the occipital and ascending pharyngeal arteries and meningohypophyseal trunk should be assessed to facilitate the detection of a cranial dural arteriovenous fistula, particularly in the transverse-sigmoid and petrous regions.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 97%