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1、DetectionandClassificationofCranialDuralArteriovenousFistulasUsing4D-CTAngiography:ORIGINALRESEARCHInitialExperienceP.W.A.WillemsBACKGROUNDANDPURPOSE:ThecriterionstandardtodiagnoseandclassifycranialDAVFsisDSA.P.A.BrouwerSincethisisinvasive,relativelyexpensiveandtime-consuming,anoninvasi
2、vealternativeisofinterest.Weaimedtoevaluatethecapabilitiesandpitfallsof4D-CTAinaconsecutiveseriesofpatientswhoJ.J.BarfettpresentedwithanewlydiagnosedcranialDAVF,asdemonstratedbyconventionalDSA.K.G.terBruggeMATERIALSANDMETHODS:ElevenpatientswereincludedinthisstudyafterbiplaneDSAdemon-T.K
3、ringsstratedacranialDAVF.Theysubsequentlyunderwent4D-CTAimagingbyusinga320-detectorCTscanner.DSAand4D-CTAstudieswereindependentlyreadby2blindedobservers,byusingastandardizedscoringsheet.4D-CTAresultswereanalyzedwithDSAasthecriterionstandard.RESULTS:In10cases,therewasfullagreementbetween
4、DSAand4D-CTAregardingtheBordenclassification.However,intheremainingpatient,aslow-fillingDAVFwithalowshuntvolumewasmissedbybothreaderson4D-CTA.Inall10detectedcases,1ofthemajorcontributingarteriescouldbeidentifiedwith4D-CTA.Although,byusingDSA,the2observersidentifiedadditionalarterialfee
5、dersin7and8cases,respectively,thesediscrepanciesdidnotinfluenceclinicaldecisionmaking.CONCLUSIONS:Althoughnovel4D-CTAimagingmaynotruleoutasmallslow-flowDAVF,itappearstobeavaluablenewadjunctinthenoninvasivediagnosticwork-up,treatmentplanning,andfollow-upofpatientswithcranialDAVFs.ABBREVI
6、ATIONS:CTACTangiography;DAVFduralarteriovenousfistula;4D-CTA4D(time-resolved)CTA;DSAdigitalsubtractionangiography;ECAexternalcarotidartery;ICAinternalcarotidartery;IVintravenous;MRAMRangiography;trMRAtime-resolvedMRA;VAvertebralarteryBRAINDAVFscaneitherbeasymptomaticorpresentw
7、ithavarietylutionnecessarytovisualizearteriovenousshuntsorvenousofsymptoms,includinghemorrhage,focalneurologicdrainagepatterns.deficits,chronicheadache,bruit,dementia,seizures,orsignsMorerecently,time-resolvedtechniqueshaveemergedfor113,1415ofintracranialhypertension.Theaggress
