CLINICAL REPORT Simultaneous Arteriovenous Shunting and Venous Congestion Identification in Dural Arteriovenous Fistulas Using Susceptibility-Weighted Imaging: Initial Experience

SUMMARY: In this short report, we describe the potential contribution of SWI in the noninvasive evaluation of DAVFs. SWI images were compared with DSA for the identification of the location of the fistulous point, the presence of CVR, and the presence of the PPP. In 5 of 6 patients, it was possible to identify the fistulous locations depicted as hyperintensity within venous structures. Cortical venous reflux was underestimated on SWI in 3 cases of robust CVR and not identified in 2 cases of less severe CVR. The PPP seen on angiograms correlated anatomically with increased number, caliber, and tortuosity of hypointense veins seen on SWI. Furthermore, SWI was superior to conventional MR imaging in the detection of these dilated veins. These preliminary results suggest an important role for SWI in the detection and assessment of the complex hemodynamics associated with DAVFs. ABBREVIATIONS: AP anteroposterior; CVR cortical venous reflux; DAVF dural arteriovenous fistula; mIP minimum intensity projection; MIP maximum intensity projection; PPP pseudo-phlebitic pattern The clinical and neuroradiologic diagnosis of DAVFs is of-ten challenging. A wide spectrum of clinical presentation has been described.1,2 Similarly, the imaging findings are often nonspecific and may mimic a variety of conditions. Most ag