RSNA 2011 

Abstract Archives of the RSNA, 2011


SSE17-06

Can a Negative Orbital-Color-Doppler-US (OCDUS) Examination Avoid Angiography in Patients with a Suspect Diagnosis of Intracranial-Arterio-Venous-Fistulas (IAVF)?

Scientific Formal (Paper) Presentations

Presented on November 28, 2011
Presented as part of SSE17: Neuroradiology (Medley II)

Participants

Massimo Venturini MD, Presenter: Nothing to Disclose
Claudia Godi MD, Abstract Co-Author: Nothing to Disclose
Stefania Bianchi Marzoli, Abstract Co-Author: Nothing to Disclose
Franco Simionato, Abstract Co-Author: Nothing to Disclose
Giulia Agostini, Abstract Co-Author: Nothing to Disclose
Alessandro Del Maschio MD, Abstract Co-Author: Nothing to Disclose

PURPOSE

Digital Subtraction Angiography (DSA) represents the gold standard technique to diagnose and treat by transcatheter embolization IAVF, a relatively rare disease. Several case reports show that OCDUS is able to diagnose IAVF with an anterior drainage through the finding of dilation and flow changes of the Superior Ophthalmic Vein (SOV). Our aim was to assess OCDUS in the IAVF diagnosis using DSA as gold standard.  

METHOD AND MATERIALS

From 2000 to 2010, 22 symptomatic (exophthalmos and/or hyperemia) consecutive patients (17 females, 5 males; mean age =61) were enrolled and submitted to a complete ophthalmologic examination, OCDUS and DSA. Both eyes (total=43) were studied with OCDUS (ATL-Philips HDI-5000; 5-12-MHz linear-probe), performed by the same operator blinded to the DSA finding. Patients were studied in supine position with closed eyelids using transversal and longitudinal images, performed also during Valsalva maneuver. Positive IAVF diagnosis with OCDUS was based on the finding of SOV with reversed, arterialized, and low resistance (RI<0.5) blood flow. Sensibility, specificity, PPV, NPV, and accuracy of OCDUS were calculated separately for patients and total eyes, using DSA as gold standard.  

RESULTS

Considering the 22 patients, 18/22 were positive at both OCDUS and DSA (DSA demonstrated 16 dural fistulas and 2 carotid-cavernous-sinus-fistulas), while 4/22 patients were negative at both OCDUS and DSA: hence, sensibility, specificity, PPV, NPV, and accuracy of OCDUS were all of 100%. Considering the 43 eyes, 24/43 were positive at both OCDUS and DSA, while 18/43 were negative at both OCDUS and DSA. Therefore sensibility, specificity, PPV, NPV, and accuracy of OCDU were as follows: 100%, 94.7%, 96%, 100%, and 99.67%. One false positive and no false negatives were recorded at OCDUS.  

CONCLUSION

OCDUS is a valid, non invasive diagnostic tool to diagnose IAVF with anterior drainage. On the basis of our finding of a NPD of 100% considering both patients and eyes, we believe that OCDUS, performed by an experienced operator, could avoid an invasive DSA in patients with a suspect IAVF diagnosis.    

CLINICAL RELEVANCE/APPLICATION

OCDUS could avoid an invasive angiography in patients with a suspect IAVF diagnosis.  

Cite This Abstract

Venturini, M, Godi, C, Bianchi Marzoli, S, Simionato, F, Agostini, G, Del Maschio, A, Can a Negative Orbital-Color-Doppler-US (OCDUS) Examination Avoid Angiography in Patients with a Suspect Diagnosis of Intracranial-Arterio-Venous-Fistulas (IAVF)?.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11012187.html