Cranial Dural Arteriovenous Fistulas: Can Noninvasive Imaging Predict Angiographic Findings?

Abstract

Objective: To access the practical of non-invasive diagnostic tools including computed tomography (CT) and
magnetic resonance imaging (MRI) to determining the characteristics and aggressiveness of a cranial dural
arteriovenous fistula (DAVF).
Methods: Retrospective review of patients with cranial DAVFs who had registered at the Interventional Neuroradiology
Center, Siriraj Hospital between January 2007 and December 2016 was performed. The pre-treatment imaging findings
were recorded for presence of diagnostic criteria of DAVF, number and location of shunts, and aggressiveness of
the disease. Cerebral angiography was used as standard reference in each patient.
Results: There were 86 patients with 119 DAVFs, of which 70.6% were aggressive type. By non-invasive imaging
criteria, the shunt detection rate was 95.3%. Inaccuracy of localization and aggressiveness pattern of the disease
occurred in 10.4% and 5.9% of the cases respectively. Dural sinus thrombosis was shown in 38%. MRI was superior
to CT in accuracy of multiplicity (76.7% VS 55.3%) and identification of aggressiveness (90.2% VS 80%).
Conclusion: Both CT scan and conventional MRI have capability in detection of DAVFs and identification of the
disease aggressiveness. Diagnostic limitation and mistaken aggressiveness can occur in patients who have DAVFs
with dural sinus drainage only. CT or MRI should be used in practice as the initial work up, with clinical correlation,
to identify patients with DAVFs who require endovascular treatment at the appropriate time.