Kouichi Asahi MD, Presenter: Nothing to Disclose

Masaaki Hori MD, Abstract Co-Author: Nothing to Disclose

Atsushi Nakanishi MD, PhD, Abstract Co-Author: Nothing to Disclose

Nozomi Hamasaki, Abstract Co-Author: Nothing to Disclose

Shuji Sato, Abstract Co-Author: Nothing to Disclose

Ryohei Kuwatsuru MD, Abstract Co-Author: Nothing to Disclose

Shigeki Aoki MD, Abstract Co-Author: Nothing to Disclose

High signal in the left sigmoid sinuses and/or internal jugular vein detected by time-of-flight magnetic resonance angiography (TOF-MRA) can be misdiagnosed as dural arteriovenous fistula (AVF). So far contrast material was indispensable to diagnose dural AVF with angiography, MRI, and CT angiography. Time-SLIP (time-space labeling inversion pulse) technique MRA, which used multi TIs, could visualize blood flow like DSA without contrast material. The purpose of this study is to clarify whether Time-SLIP technique can be differentiate between benign (normal) retrograde filling of dural sinus from pathologic visualization of dural sinus due to AVF.

8 patients with high signal in the left sigmoid sinus on TOF-MRA were recruited. Five patients had dural AVF and other three were other diseases. All MRI was performed on a 1.5T MR imager (EXCELARET Vantage powered by Atlas 1.5T, Toshiba Medical Systems, Tokyo, Japan) with a twelve-channel head coil. Time-SLIP MRA sequence were as follows : 3D true-SSFP was used. TR/TE = 5.0/2.5 msec, flip angle = 120° FOV = 225×225 mm, matrix size = 192 × 240, slice gap = 5 mm, delay after IR pulse = 100-1000 msec (by 100 msec). Time-SLIP MRA were visually evaluated retrograde filling of dural sinus from anterograde pathologic visualization by two neuroradiologists blinded patient information.

Inter-reader concordance rate was 100%. In non-AVF three patients, Time-SLIP technique MRA showed retrograde flow in the internal jugular vein and the left sigmoid sinus and it could rule out dural AVF. In the early arterial phase (TI=100 ms), the jugular vein was appeared with ICA. In the middle phase (TL=300-500), the jugular vein and the left sigmoid sinus were well visualized. In the late phase (TI=500-1000 ms), the left sigmoid sinus and the left transverse sinus were filled with the time passage. Five patients diagnosed as dural AVF, it showed anterograde blood flow in the internal jugular vein and the left sigmoid sinus.

Time-SLIP technique MRA is noninvasive method to diagnose retrograde flow in the internal jugular and it can rule out  dural AVF.

Time-SLIP technique MRA is noninvasive method to diagnose retrograde flow in the internal jugular and it can rule out dural AVF.

Asahi, K, Hori, M, Nakanishi, A, Hamasaki, N, Sato, S, Kuwatsuru, R, Aoki, S, Time-resolved Three-dimensional Magnetic Resonance Digital Subtraction Angiography without Contrast Material Can Demonstrate Retrograde Filling of Dural Sinuses and May Help to Rule Out Carotid Dural Arteriovenous Fistula.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11034656.html