Quantifying the Cerebral Hemodynamics of Dural Arteriovenous Fistula in Transverse Sigmoid Sinus Complicated by Sinus Stenosis: A Retrospective Cohort Study

W.-Y. Guo; C.-C.J. Lee; C.-J. Lin; H.-C. Yang; H.-M. Wu; C.-C. Wu; W.-Y. Chung; K.-D. Liu

doi:10.3174/ajnr.A4960

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Fig 1.
Quantitative color-coded digital subtraction angiography of the anteroposterior (A) and lateral (B) views of a Cognard type I DAVF. ROI1: internal carotid artery; ROI2: ipsilateral normal transverse sinus; ROI3: internal jugular vein; ROI4: parietal vein; ROI5: vein of Labbé; ROI6: prestenotic segment; ROI7: poststenotic segment. The Arrow indicates the stenotic sinus segment.
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Fig 2.
A, Quantitative digital subtraction angiography of a healthy subject. B, One single peak appears at 9.87 seconds (venous phase) in the internal jugular vein. C, Quantitative digital subtraction angiography of a Cognard type I DAVF in the left transverse sinus in a 50-year-old woman. D, Time-density curve of the internal jugular vein demonstrates 2 peaks. The first peak comes from arterial flow from the DAVF shunt; the second peak comes from blood flow from normal brain parenchyma. E, Quantitative digital subtraction of a case of Cognard type IIa+b in the left transverse sigmoid sinus in a 73-year-old man. F, Only a single peak can be depicted in a time-density curve of the ipsilateral jugular vein, indicating that it lacks the drainage function of the normal brain.
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Fig 3.
The process of case selection from the angiosuite logbook for our study cohort.
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Fig 4.
Kaplan-Meier analysis of complete regression (A) and favorable outcomes (B) among types I, IIa, and IIa+b or higher.
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Fig 5.
Quantitative DSA of cases of Cognard type I (A), Cognard type IIa (B), and Cognard type IIa+b (C). Severe sinus stenosis is more commonly encountered in more aggressive DAVF types. The TFT (TTP of the internal jugular vein) was largest in type IIa+b (green), followed by types IIa (yellow-green) and I (yellow). Progressive shortening of the TTP in the superior sagittal sinuses in type IIa and type IIa+b is also depicted.

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Table 1:

Comparison of patient characteristics in 3 different groups: type I, type IIa, and types with CVD^{^a}

	Type I	Type IIa	Types with CVD
No.	22	8	13
Age (yr)	58 (52.8–64.2)	54 (35.5–73.7)	52 (41.3–63.8)
Headaches	4 (18.2; 2.1–34.3)	3 (37.5; 6.2–79.5)	4 (30.8; 5.7–55.9)
Hemorrhage/neurologic deficits	0	0	8 (61.5; 35.1–88.0)^{^b}
Venous stenosis	8 (36.4; 16.3–56.5)^{^b}	8 (100%)	11 (84.6; 65–100)
Loss of double peak	7 (31.8; 12.4–51.3)^{^c}	8 (100%)^{^c}	9 (69.2; 44.1–94.3)^{^c}

↵a The numbers inside the parentheses for age indicate the 95% confidence intervals. The numbers inside the parentheses for headaches, hemorrhage/neurologic deficits, venous stenosis, and loss of double peak indicate the percentage of the observed variable in the group with 95% confidence intervals.
↵b Significant difference compared with the other 2 groups.
↵c Significant difference across the 3 groups.

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Table 2:

Intra- and interobserver variability in different time parameters^{^a}

	Reader A	Reader B	Interobserver
TFT	0.98 (0.96–0.99)	0.97 (0.96–0.98)	0.94 (0.90–0.97)
TST	0.97 (0.95–0.99)	0.96 (0.94–0.99)	0.93 (0.90–0.96)
TTP_PV	0.98 (0.96–0.99)	0.95 (0.90–0.97)	0.91 (0.86–0.94)
TTP_VL	0.98 (0.96–0.99)	0.92 (0.89–0.96)	0.92 (0.87–0.94)
TTP_TS	0.95 (0.97–0.91)	0.96 (0.93–0.99)	0.94 (0.90–0.98)

Note:—TTP_TS indicates TTP of the ipsilateral normal transverse sinus.
↵a Data are 95% CI.

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Table 3:

Comparison of different time parameters among the 3 groups^{^a}

	Type I	Type IIa	Types with CVD
TFT	1.04 (0.80–1.00)	0.42 (0.27–0.4)	2.09 (1.06–2.26)^{^b}
TST	0.03 (0–0)	0.34 (0.3–0.53)^{^b}	0.67 (−0.54–0.8)^{^b}
TTP_PV	4.57 (4.14–5.60)	4.25 (3.20–4.94)	5.6 (4.13–6.26)
TTP_VL	4.20 (4.26–5.20)	4.40 (3.50–6.00)	1.4 (0.93–3.46)^{^b}
TTP_TS	6.01 (4.93–7.47)^{^b}	1.17 (1.06–3.6)	1.1 (1.06–1.86)

Note:—TTP_TS indicates TTP of the ipsilateral normal transverse sinus.
↵a Data are 95% CI.
↵b Significant difference compared with the other 2 groups.

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Table 4:

Clinical characteristics, treatment strategy, and response in 13 patients with DAVF types with CVD

Case No.	Sex	Age (yr)	Cognard Type before SRS	Treatment	Cognard Type after Venoplasty/Stent	Treatment after SRS	Follow-Up Duration (mo)	Response
1	F	41	IIa+b	Venoplasty/stent	IIa	–	46	PR
2	M	63	IIa+b	Venoplasty	IIa	–	38	CR
3	M	56	IIa+b	Venoplasty/stent	IIa	–	19	PR^{^a}
4	M	45	IIa+b	–	NA	–	15	CR
5	F	63	IIa+b	Venoplasty/stent	IIa+b	–	10	PR^{^a}
6	M	73	IIa+b	–	NA	–	10	PR
7	M	17	IIa+b	Venoplasty/stent	IIa+b	–	6	PR
8	M	55	IIb	–	NA	–	5.6	PR
9	M	19	III	–	NA	TAE twice	17	PR
10	M	27	III	Venoplasty	IIa	–	27	CR^{^b}
11	M	12	III	–		–	13	CR
12	M	27	IV	–		–	27.6	PR
13	M	55	IV	–		–	NA	NA

Note:—TAE indicates transarterial embolization; CR, complete regression; PR, partial regression; –, no adjunct treatment was performed; NA, not available.
↵a Restenosis of sinus after venoplasty and stenting.
↵b Asymptomatic intracranial hemorrhage on MR imaging.