Massimo Venturini, Presenter: Nothing to Disclose

Federico D Ascenzo, Abstract Co-Author: Nothing to Disclose

Stefania Bianchi Marzoli, Abstract Co-Author: Nothing to Disclose

Francesco Scomazzoni, Abstract Co-Author: Nothing to Disclose

Franco Simionato, Abstract Co-Author: Nothing to Disclose

Alessandro Del Maschio MD, Abstract Co-Author: Nothing to Disclose

Several case reports showed dilatation and flow’s modifications of Superior Ophthalmic Vein (SOV) with OCD in cases of CCSF. Digital angiography represents the gold standard technique to diagnose and to clearly define site and venous drainage of CCSF, a rare disease. Our aim was to evaluate OCD in the diagnosis of CCSF, in a relative large number of patients.

Both eyes of 20 patients, in supine position with closed eyelids, with clinical suspect (pulsating exophthalmos, redness, increased intraocular pressure) of CCSF were examined with OCD (ATL-Philips HDI 5000 / 5-12 Mhz linear probe). Blood flow of Superior ophthalmic veins (SOV), inferior ophthalmic veins (IOV), central retinal veins, central retinal arteries, ophthalmic arteries was examined with OCD. The caliber of each vessel, the direction of blood flow and the following flow parameters were considered: maximum and minimum velocities for veins; peak systolic, end diastolic velocities and resistance index (RI) for arteries. Positive diagnosis with OCD was based on the finding of SOV (and IOV) dilated, with reversed, arterialized and low resistance (RI<0.50) blood flow. Definitive diagnosis of CCSF was based on digital angiography that was performed in all patients after OCD examination.

CCSF were correctly diagnosed with OCD in 19/20 patients, with unsuccessful diagnosis in one patient. SOV showed reversed, arterialized and low resistance blood flow in 19/20 cases, with bilateral orbital involvement in 4 cases. SOV were dilated in 14/19 patients, undilated in 5/19. IOV dilated with reversed and arterialized flow were demonstrated in 8/20 cases (bilateral in 2 cases).

An accurate and non invasive diagnosis of CCSF with ocular involvement before angiographic diagnostic confirmation was obtained with OCD, due to SOV (and IOV) blood flow changes, also in case of undilatation of the orbital veins. OCD can be also used to monitor CCSF after an angiographic embolization.

Venturini, M, D Ascenzo, F, Bianchi Marzoli, S, Scomazzoni, F, Simionato, F, Del Maschio, A, Noninvasive Diagnosis with Orbital Color Doppler (OCD) of Carotid Cavernous Sinus Fistulas (CCSF): Personal Experience in 20 Cases.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4417152.html