MRI and MR Angiography Findings to Differentiate Jugular Venous Reflux From Cavernous Dural Arteriovenous Fistula

作者：Kim Eunhee; Kim Jae Hyoung^*; Choi Byung Se; Jung Cheolkyu; Lee Dong Hoon

来源：American Journal of Roentgenology, 2014, 202(4): 839-846.

DOI：10.2214/AJR.13.11048

• cavernous dural arteriovenous fistula
• jugular venous reflux
• MR angiography
• MRI

OBJECTIVE. Both jugular venous reflux (JVR) and cavernous dural arteriovenous fistula (DAVF) manifest as abnormal venous signal intensities on time-of-flight (TOF) MR angiography (MRA). We investigated brain MRI and MRA findings that might differentiate JVR from cavernous DAVF.
MATERIALS AND METHODS. Forty-one patients with abnormal venous signal intensities on TOF MRA in the cavernous sinus and its vicinity were selected from 1508 patients who had undergone TOF MRA over the previous 6 months. For comparison, the examinations of 26 patients with cavernous DAVF who had undergone imaging over the previous 8 years were collected. The following findings were assessed: the side and location of abnormal venous signal intensities on intracranial TOF MRA; the signal intensity of the proximal jugular vein on T2-weighted imaging; whether there was early opacification of the cavernous sinus in the arterial phase of contrast-enhanced MRA (CE-MRA); the side of jugular venous drainage in the arteriovenous phase of CE-MRA; and whether retrograde jugular venous flow was seen on neck TOF MRA.
RESULTS. Abnormal venous signal intensities were seen on the left side in 73% of patients with JVR and 58% of patients with cavernous DAVF; involvement of the cavernous sinus was found in 12% of patients with JVR and 100% of patients with cavernous DAVF. Increased signal intensity in the ipsilateral jugular vein on T2-weighted imaging was found in 73% of JVR patients and 4% of cavernous DAVF patients. Early opacification of the cavernous sinus in the arterial phase of CE-MRA, ipsilateral jugular venous drainage in the arteriovenous phase of CE-MRA, and ipsilateral retrograde jugular venous flow on neck TOF MRA were found in 0%, 0%, and 63%, respectively, of JVR patients and in 100%, 100%, and 0%, respectively, of cavernous DAVF patients.
CONCLUSION. JVR and cavernous DAVF can be differentiated from one another using MRI and MRA.

• 出版日期2014-4