Article Figures & Data
Figures
- Fig 1.
A, Anteroposterior (top row), lateral (second row), and axial (bottom row) projections of maximum-intensity 4D-CE-MRA images (2.9/1.4, 20° flip angle) reconstructed in a 65-year-old man with DAVF at the left transverse sinus. There is an early depiction of the left transverse and the right transverse-to-sigmoid sinuses at the early arterial (left) to the arterial phase (middle). The fistula site (arrow) appears to be the left transverse sinus, and the DAVF is mainly supplied by branches from the occipital artery (arrowheads). Venous drainage is from the left transverse to the right transverse to the sigmoid sinus. The left sigmoid sinus is not visualized at the venous phase (small arrow). In this DAVF, both readers judged that the occipital artery was the main arterial feeder, the left transverse sinus was the fistula site, and venous drainage was type 1. B, Anteroposterior (upper) and lateral (lower) projections of digital subtraction angiography (DSA) (left) and 4D CE-MRA (right) during the arterial phase in the patient in A. DSA shows an arteriovenous shunt (arrow) at the left transverse sinus, which is supplied by branches from the occipital artery (arrowheads). 4D-CE-MRA also depicts the main arterial feeders (arrowheads), the fistula site (arrow), and the venous drainage route.
- Fig 2.
A, Anteroposterior (top row), lateral (second row), and axial (bottom row) projections of maximum-intensity 4D-CE-MRA images (2.9/1.4, 20° flip angle) of a 71-year-old woman with DAVF at the left cavernous sinus. There is an early depiction of the bilateral cavernous sinuses (arrows) at the early arterial phase (left). The bilateral superior ophthalmic veins (arrowheads) are dilated during the arterial (middle) and late arterial phase (right). The bilateral internal maxillary arteries are well visualized (small arrows). Retrograde cortical venous drainage is via the left cerebral cortical veins (circle). Both readers judged that this DAVF was primarily fed by the internal maxillary artery, that the cavernous sinus was the fistula site, and that venous drainage was type 2. B, Anteroposterior (upper) and lateral (lower) projections of DSA (left) and 4D-CE-MRA (right) images in the arterial phase in the patient in A. DSA shows an arteriovenous shunt (arrow) at the left cavernous sinus. It is supplied by branches from the left internal maxillary (arrowhead) and middle meningeal arteries (small arrow). The right cavernous sinus (small arrowhead) is depicted via the intercavernous sinus. Retrograde cortical venous drainage is via the left cerebral cortical veins (circle). 4D-CE-MRA also depicts the main arterial feeders (arrowhead, small arrow), the fistula site (arrow), and the venous drainage pattern (circle).
Tables
4D-CE-MRA Interobserver Agreementb 4D-CE-MRA Consensus Reading DSA Intermodality Agreementc Reader 1 Reader 2 Fistula site CS 8 8 17 (94) 8 8 18 (100) TS 8 8 [0.72–0.99] 8 8 [0.81–1.00] FM 2 1 2 2 Other sites 0 1 0 0 Main feeders IMA-MMA 7 7 14 (78) 7 7 16 (89) APA 7 5 [0.52–0.94] 5 4 [0.65–0.98] OA 3 5 6 7 ICA 0 0 0 0 Other feeders 1 1 0 0 Venous drainage Type 1d 14 13 16 (89) 13 13 18 (100) Type 2e 3 4 [0.65–0.98] 4 4 [0.81–1.00] Type 3f 1 1 1 1 -
Note:—4D-CE-MRA indicates 4D contrast-enhanced MR angiography; DSA, digital subtraction angiography; DAVF, dural arteriovenous fistula; CS, cavernous sinus; TS, transverse-sigmoid sinus; FM, sinus adjacent to the foramen magnum; IMA-MMA, internal maxillary artery and/or middle meningeal artery; APA, ascending pharyngeal artery; OA, occipital artery; ICA, internal carotid artery; CI, confidence interval.
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a Data are number of DAVFs. Data in parentheses are the percentage of concordance, and data in brackets are exact CIs.
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b Agreement of 4D-CE-MRA between reader 1 and reader 2.
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c Agreement between the consensus reading at 4D CE-MRA of reader 1 and reader 2 and DSA.
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d Venous drainage directly into the dural venous sinus.
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e Venous drainage into the dural venous sinus with cortical venous reflux.
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f Venous drainage directly into the subarachnoid veins (cortical venous reflux only).
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Main Arterial Supply Fistula Site Venous Drainage Interobserver agreementb 0.59 (0.29–0.90) 0.91 (0.73–1.00) 0.86 (0.60–1.00) Intermodality agreementc 0.68 (0.40–0.96) 1.00 (1.00–1.00) 1.00 (1.00–1.00) -
a Data are κ statistics, with 95% CIs in parentheses.
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b Agreement of 4D-CE-MRA between reader 1 and reader 2.
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c Agreement between the consensus reading at 4D-CE-MRA of reader 1 and reader 2 and DSA.
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