scholarly journals A case of recurrent cavernous sinus dural arteriovenous fistula arising after superselective shunt occlusion and detected by venous arterial spin labeling

2021 ◽  
Vol 12 ◽  
pp. 594
Author(s):  
Hiromu Sunada ◽  
Ryosuke Maeoka ◽  
Ichiro Nakagawa ◽  
Hiroyuki Nakase ◽  
Hideyuki Ohnishi
Keyword(s):  
Arteriovenous Fistula ◽  
Cavernous Sinus ◽  
Arterial Spin Labeling ◽  
Dural Arteriovenous Fistula ◽  
Spin Labeling ◽  
Digital Subtraction ◽  
Resonance Imaging ◽  
Shunt Occlusion ◽  
Paradoxical Worsening ◽  
The Right

Background: Superselective shunt occlusion (SSSO) for cavernous sinus dural arteriovenous fistula (CSDAVF) avoids the risk of cranial nerve palsy, unlike entire sinus packing, but requires paying attention to recurrence. Distinguishing between true and paradoxical worsening of postoperative ophthalmic symptoms using a less-invasive modality is often difficult. Here, we report a case of true worsening of neuro-ophthalmic symptom by recurrent CSDAVF detected by venous-arterial spin labeling (ASL) on magnetic resonance imaging. Case Description: A 55-year-old woman with neither contributory medical history nor previous head trauma presented with neuro-ophthalmic symptoms and pulsatile tinnitus. Digital subtraction angiography (DSA) revealed CSDAVF with multiple shunted pouches. She underwent successful transvenous SSSO, but neuroophthalmic symptom worsened after SSSO and venous-ASL revealed increased signal intensity in the right superior orbital vein (SOV). DSA confirmed recurrent CSDAVF and additional transvenous embolization was performed. Neuro-ophthalmic symptoms and venous-ASL hyperintensity on SOV improved postoperatively. Conclusion: Venous-ASL is noninvasive and seems useful for detecting true worsening of neuro-ophthalmic symptoms of recurrent CSDAVF.

Arterial Spin Labeling for the Etiological Workup of Intracerebral Hemorrhage in Children

Stroke ◽  
2021 ◽  
Author(s):  
Jean François Hak ◽  
Grégoire Boulouis ◽  
Basile Kerleroux ◽  
Sandro Benichi ◽  
Sarah Stricker ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Magnetic Resonance ◽  
Intracerebral Hemorrhage ◽  
Computed Tomography Angiography ◽  
Arterial Spin Labeling ◽  
Diagnostic Performance ◽  
Spin Labeling ◽  
Digital Subtraction ◽  
Resonance Imaging

Background and Purpose: Pediatric nontraumatic intracerebral hemorrhage accounts for half of stroke in children. Early diagnostic of the causative underlying lesion is the first step toward prevention of hemorrhagic recurrence. We aimed to investigate the performance of arterial spin labeling sequence (ASL) in the acute phase etiological workup for the detection of an arteriovenous shunt (AVS: including malformation and fistula), the most frequent cause of pediatric nontraumatic intracerebral hemorrhage. Methods: Children with a pediatric nontraumatic intracerebral hemorrhage between 2011 and 2019 enrolled in a prospective registry were retrospectively included if they had undergone ASL-magnetic resonance imaging before any etiological treatment. ASL sequences were reviewed using cerebral blood flow maps by 2 raters for the presence of an AVS. The diagnostic performance of ASL was compared with admission computed tomography angiography, other magnetic resonance imaging sequences including contrast-enhanced sequences and subsequent digital subtraction angiography. Results: A total of 121 patients with pediatric nontraumatic intracerebral hemorrhage were included (median age, 9.9 [interquartile range, 5.8–13]; male sex 48.8%) of whom 76 (63%) had a final diagnosis of AVS. Using digital subtraction angiography as an intermediate reference, visual ASL inspection had a sensitivity and a specificity of, respectively, 95.9% (95% CI, 88.5%–99.1%) and 79.0% (95% CI, 54.4%–94.0%). ASL had a sensitivity, specificity, and accuracy of 90.2%, 97.2%, and 92.5%, respectively for the detection of the presence of an AVS, with near perfect inter-rater agreement (κ=0.963 [95% CI, 0.912–1.0]). The performance of ASL alone was higher than that of other magnetic resonance imaging sequences, individually or combined, and higher than that of computed tomography angiography. Conclusions: ASL has strong diagnostic performance for the detection of AVS in the initial workup of intracerebral hemorrhage in children. If our findings are confirmed in other settings, ASL may be a helpful diagnostic imaging modality for patients with pediatric nontraumatic intracerebral hemorrhage. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifiers: 3618210420, 2217698.

Arterial spin labeling magnetic resonance imaging at short post-labeling delay reflects cerebral perfusion pressure verified by oxygen-15-positron emission tomography in cerebrovascular steno-occlusive disease

2020 ◽  
pp. 028418512091711
Author(s):  
Hiroshi Itagaki ◽  
Yasuaki Kokubo ◽  
Kanako Kawanami ◽  
Shinji Sato ◽  
Yuki Yamada ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Blood Flow ◽  
Arterial Spin Labeling ◽  
Cerebral Perfusion ◽  
Perfusion Pressure ◽  
Spin Labeling ◽  
Occlusive Disease ◽  
Resonance Imaging ◽  
Arterial Transit Time ◽  
The Right

Background Arterial transit time correction by data acquisition with multiple post-labeling delays (PLDs) or relatively long PLDs is expected to obtain more accurate imaging in cases of the cerebrovascular steno-occlusive disease. However, there have so far been no reports describing the significance of arterial spin labeling (ASL) images at short PLDs regarding the evaluation of cerebral circulation in ischemic cerebrovascular disease. Purpose To clarify the role of short-PLD ASL in cerebrovascular steno-occlusive disease. Material and Methods Fifty-three patients with cerebrovascular steno-occlusive disease were included in this study. All patients underwent ASL magnetic resonance imaging and 15O-PET within two days of each modality. To compare the ASL findings with each parameter of PET, the right-to-left (R/L) ratio, defined as the right middle cerebral artery (MCA) value/left MCA value, was calculated. Results There is a significant correlation between the ASL images at a short PLD and the ratio of cerebral blood flow and cerebral blood volume by 15O-PET, which may accurately reflect the cerebral perfusion pressure. A receiver operating characteristic curve analysis indicated that ASL images at PLD 1000 and 1500 ms were more accurate than at PLD 2000–3000 ms for the detection of a ≥10% change in the PET cerebral blood flow. Conclusion ASL images at shorter PLDs may be useful at least as a screening modality to detect the changes in the cerebral circulation in cerebrovascular steno-occlusive disease. We must evaluate ASL images at multiple PLDs while considering the arterial transit time of each case at present.

scholarly journals Serious myelopathy due to magnetic resonance imaging-occult arteriovenous fistula: Case report of petrous ridge dural arteriovenous fistula

2015 ◽  
Vol 21 (5) ◽  
pp. 609-612
Author(s):  
Hyun Jeong Kim ◽  
In Sup Choi
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Slow Flow ◽  
Digital Subtraction ◽  
Resonance Imaging ◽  
Progressive Myelopathy ◽  
Vascular Origin ◽  
Magnetic Resonance Imaging Mri

Background and purpose We present a case of magnetic resonance imaging (MRI)-occult intracranial dural arteriovenous fistula (DAVF) with serious cervical myelopathy and review the pathophysiological background. Summary of case A 61-year-old man had suffered from progressive neurological deterioration. He had demonstrated swollen spinal cord with diffuse enhancement and no dilated vascularity on MRI. Finally, digital subtraction angiography revealed DAVF at the petrous ridge and it was successfully treated by embolization. Conclusion A slow flow DAVF is not readily recognizable on MRI. Whenever a patient presents with unexplainable progressive myelopathy, a possibility of vascular origin has to be considered.

scholarly journals Acute Brainstem Dysfunction Caused by Cavernous Sinus Dural Arteriovenous Fistula

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Yuwa Oka ◽  
Kenichi Komatsu ◽  
Soichiro Abe ◽  
Naoya Yoshimoto ◽  
Junya Taki ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Arteriovenous Fistula ◽  
Digital Subtraction Angiography ◽  
Cavernous Sinus ◽  
Dural Arteriovenous Fistula ◽  
Inflammatory Diseases ◽  
Digital Subtraction ◽  
Arteriovenous Fistulas ◽  
Ocular Symptoms ◽  
Brainstem Dysfunction

Symptoms of cavernous sinus dural arteriovenous fistula depend on the drainage patterns and are very diverse. Among these, brainstem dysfunction is a rare but serious complication. Here, we describe a case with isolated and rapidly progressive brainstem dysfunction due to cavernous sinus dural arteriovenous fistula. An 80-year-old woman presented with a 2-day history of progressive gait disturbance. Neurological examination revealed mild confusion, dysarthria, and left hemiparesis. Magnetic resonance imaging (MRI) revealed pontine swelling without evidence of infarction. Magnetic resonance angiography suggested a faint abnormality near the cavernous sinus. Dural arteriovenous fistula was suspected, and digital subtraction angiography was planned for the next day. Her condition had progressed to coma by the next morning. Pontine swelling worsened, and hyperintensity appeared on diffusion-weighted imaging. Digital subtraction angiography revealed a right-sided cavernous sinus dural arteriovenous fistula with venous reflux into the posterior fossa. Orbital or ocular symptoms had preceded brainstem symptoms in all nine previously reported cases, but brainstem symptoms were the only presentation in our case, making the diagnosis difficult. Some dural arteriovenous fistulas mimic inflammatory diseases when the clinical course is acute. Prompt diagnosis using enhanced computed tomography or MRI and emergent treatment are needed to avoid permanent sequelae.

Arterial Spin Labeling Magnetic Resonance Imaging Can Identify the Occlusion Site and Collateral Perfusion in Patients with Acute Ischemic Stroke: Comparison with Digital Subtraction Angiography

2019 ◽  
Vol 48 (1-2) ◽  
pp. 70-76 ◽  
Author(s):  
Yoichi Morofuji ◽  
Nobutaka Horie ◽  
Yohei Tateishi ◽  
Minoru Morikawa ◽  
Susumu Yamaguchi ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Ischemic Stroke ◽  
Magnetic Resonance ◽  
Acute Ischemic Stroke ◽  
Digital Subtraction Angiography ◽  
Arterial Spin Labeling ◽  
Spin Labeling ◽  
Collateral Flow ◽  
Digital Subtraction ◽  
Resonance Imaging

Background and Objectives: Determining the occlusion site and collateral blood flow is important in acute ischemic stroke. The purpose of the current study was to test whether arterial spin labeling (ASL) magnetic resonance imaging (MRI) could be used to identify the occlusion site and collateral perfusion, using digital subtraction angiography (DSA) as a gold standard. Method: Data from 521 consecutive patients who presented with acute ischemic stroke at our institution from January 2012 to September 2014 were retrospectively reviewed. Image data were included in this study if: (1) the patient presented symptoms of acute ischemic stroke; (2) MRI was performed within 24 h of symptom onset; and (3) DSA following MRI was performed (n = 32 patients). We defined proximal intra-arterial sign (IAS) on ASL as enlarged circular or linear bright hyperintense signal within the occluded artery and distal IAS as enlarged circular or linear bright hyperintense signals within arteries inside or surrounding the affected region. The presence or absence of the proximal IAS and distal IAS were assessed, along with their inter-rater agreement and consistency with the presence of occlusion site and collateral flow on DSA images. Results: The sensitivity and specificity for identifying occlusion site with ASL were 82.8 and 100%, respectively. Those for identifying collateral flow with ASL were 96.7 and 50%, respectively. The inter-rater reliability was excellent for proximal IAS (κ = 0.92; 95% CI 0.76–1.00) and substantial for distal IAS detection (κ = 0.78; 95% CI 0.38–1.00). Conclusions: Proximal IAS and distal IAS on ASL imaging can provide important diagnostic clues for the detection of arterial occlusion sites and collateral perfusion in patients with acute ischemic stroke.

scholarly journals Usefulness of arterial spin labeling in the evaluation for dural arteriovenous fistula of the craniocervical junction

2021 ◽  
Vol 16 (7) ◽  
pp. 1655-1659
Author(s):  
Seishiro Takamatsu ◽  
Kohei Suzuki ◽  
Yu Murakami ◽  
Kei Nomura ◽  
Junkoh Yamamoto ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Arterial Spin Labeling ◽  
Dural Arteriovenous Fistula ◽  
Spin Labeling ◽  
Craniocervical Junction

scholarly journals Extracranial arteriovenous malformation and subsequent contralateral cavernous sinus dural arteriovenous fistula showing abducens nerve palsy: illustrative case

2021 ◽  
Vol 2 (6) ◽  
Author(s):  
Atsushi Tsukada ◽  
Kiyoyuki Yanaka ◽  
Kazuhiro Nakamura ◽  
Nobuyuki Takahashi ◽  
Kuniyuki Onuma ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Cavernous Sinus ◽  
Nerve Palsy ◽  
Spontaneous Regression ◽  
Dural Arteriovenous Fistula ◽  
Abducens Nerve ◽  
Abducens Nerve Palsy ◽  
Illustrative Case ◽  
Vascular Structure ◽  
The Right

BACKGROUND Extracranial arteriovenous malformations (AVMs) are rare clinical entities and on rare occasions cause neurological symptoms. The authors report a case of an extracranial pterygoid AVM and a subsequent contralateral cavernous sinus dural arteriovenous fistula (dAVF) presenting with abducens nerve palsy. OBSERVATIONS An 80-year-old woman was referred to the authors’ hospital with left abducens nerve palsy followed by right ophthalmalgia. Magnetic resonance imaging (MRI) showed abnormal vessel staining in the left pterygoid and the right inferior petrosal sinus (IPS). Cerebral angiography revealed a left pterygoid AVM draining into the right IPS via the cavernous sinus (CS). A dAVF in the right CS was also revealed. The right ophthalmalgia disappeared spontaneously, and, 4 months later, the left abducens nerve palsy also disappeared after conservative management. Follow-up MRI showed spontaneous regression of the AVM and dAVF. The disappearance of the dAVF was considered to be due to spontaneous regression of the left pterygoid AVM and the consequent decrease in venous pressure of the CS, and the symptoms eventually disappeared. LESSONS The authors treated an extremely rare case of extracranial AVM with dramatic changes in vascular structure and symptoms. Understanding of the pathophysiology between symptoms and dynamic changes in the vascular structure is essential for providing the appropriate treatment.

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