Download PDF
CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2018; 76(08): 568
DOI: 10.1590/0004-282X20180056
Images in Neurology

Added value of arterial spin-labeling (ASL) and susceptibility weighted-images (SWI) in detecting a mild symptomatic intracranial arteriovenous fistula

A importância das técnicas arterial spin-labeling e susceptibility weighted-images na detecção de fistulas arteriovenosas
Felipe T. Pacheco
1   Faculdade de Medicina da Santa Casa de São Paulo, Divisão de Neurorradiologia, São Paulo SP, Brasil;
2   Diagnósticos da América, São Paulo SP, Brasil.
,
Bruna Bianca Allegro
1   Faculdade de Medicina da Santa Casa de São Paulo, Divisão de Neurorradiologia, São Paulo SP, Brasil;
2   Diagnósticos da América, São Paulo SP, Brasil.
,
Igor Gomes Padilha
1   Faculdade de Medicina da Santa Casa de São Paulo, Divisão de Neurorradiologia, São Paulo SP, Brasil;
2   Diagnósticos da América, São Paulo SP, Brasil.
,
Renato Hoffmann Nunes
1   Faculdade de Medicina da Santa Casa de São Paulo, Divisão de Neurorradiologia, São Paulo SP, Brasil;
2   Diagnósticos da América, São Paulo SP, Brasil.
,
Antçnio José da Rocha
1   Faculdade de Medicina da Santa Casa de São Paulo, Divisão de Neurorradiologia, São Paulo SP, Brasil;
2   Diagnósticos da América, São Paulo SP, Brasil.
› Author Affiliations
› Further Information
Also available at
 
 PDF Download Permissions and Reprints

Dural arteriovenous fistulas consist of a direct arteriovenous shunt, across the dural layer, without an intervening capillary nidus. An intracranial dural arteriovenous fistula diagnosis remains challenging as symptoms vary according to their span[1].

A 26-year-old woman presented with left pulsatile tinnitus one year after an intracranial venous thrombosis. Conventional brain MRI sequences were unremarkable. However, arterial spin-labeling and susceptibility weighted imaging suggested blood flow abnormalities in the left posterolateral tentorial region ([Figure]), supporting suspicion of a dural arteriovenous fistula. This diagnosis was confirmed by magnetic resonance angiography, allowing appropriate treatment. This report reinforces the importance of these new techniques on high magnetic field MRI to confidently reveal some vascular disorders that have remained obscured until recently. It is also important to highlight the advantage that both techniques do not require contrast administration[2].

Zoom Image
Figure (A) Abnormal signal intensities due to oxygenated blood in arterial reflux into venous system (transverse and sagittal superior sinuses depicted on arterial spin-labeling perfusion – arrows) and (B) axial susceptibility weighted image (arrow). Sagittal maximum intensity projection (C) identified prominent left occipital artery (dotted arrow) and the connections between small adjacent transosseous branches and dural sinus, confirming a dural arteriovenous fistula (arrow). Coronal magnetic resonance angiography using maximum intensity projection (D) showed numerous extradural arteries converging to the posterolateral petrotentorial region (arrows).

#

Conflict of interest:

There is no conflict of interest to declare.

Author Contributions

Dra. Allegro, Dr. Padilha and Dr. Nunes: data collection and drafting the manuscript; Dr. Pacheco and Dr. Rocha: study concept and revising the manuscript.


  • References

  • 1 Reynolds MR, Lanzino G, Zipfel GJ. Intracranial dural arteriovenous fistulae. Stroke. 2017;48(5):1424-31. https://doi.org/10.1161/STROKEAHA.116.012784
  • 2 Hodel J, Leclerc X, Kalsoum E, Zuber M, Tamazyan R, Benadjaoud MA et al. Intracranial arteriovenous shunting: detection with arterial spin-labeling and susceptibility-weighted imaging combined. AJNR Am J Neuroradiol. 2017 Jan;38(1):71-6. https://doi.org/10.3174/ajnr.A4961

Address for correspondence

Felipe T. Pacheco
Rua Doutor Cesário Motta Junior 112; 01221-020 São Paulo SP
Brasil   

Publication History

Received: 18 February 2018

Accepted: 31 March 2018

Article published online:
23 August 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

  • References

  • 1 Reynolds MR, Lanzino G, Zipfel GJ. Intracranial dural arteriovenous fistulae. Stroke. 2017;48(5):1424-31. https://doi.org/10.1161/STROKEAHA.116.012784
  • 2 Hodel J, Leclerc X, Kalsoum E, Zuber M, Tamazyan R, Benadjaoud MA et al. Intracranial arteriovenous shunting: detection with arterial spin-labeling and susceptibility-weighted imaging combined. AJNR Am J Neuroradiol. 2017 Jan;38(1):71-6. https://doi.org/10.3174/ajnr.A4961

  Permissions and Reprints
Zoom Image
Figure (A) Abnormal signal intensities due to oxygenated blood in arterial reflux into venous system (transverse and sagittal superior sinuses depicted on arterial spin-labeling perfusion – arrows) and (B) axial susceptibility weighted image (arrow). Sagittal maximum intensity projection (C) identified prominent left occipital artery (dotted arrow) and the connections between small adjacent transosseous branches and dural sinus, confirming a dural arteriovenous fistula (arrow). Coronal magnetic resonance angiography using maximum intensity projection (D) showed numerous extradural arteries converging to the posterolateral petrotentorial region (arrows).