Learning objectives
To outline the advantages of Color Doppler Imaging (CDI) and Transcranial Doppler Imaging (TCDI) in the diagnosis and follow-up of carotid-cavernous fistulas (CCF) with emphasis on the primary diagnostic Doppler aspects and to offer arguments when they may be the most suitable imaging modality.
Background
ANATOMY
Anatomically,
the cavernous sinuses (CS) are paired structures located immediately lateral on either side of the sella turcica and they measure approximatively 2 cm anteroposteriorly,
1.3 cm in vertical dimension and 1 cm lateral width.
The cavernous sinus is a septate venous channel formed by the splitting in two layers of the dura.
The outer layer of the dura is in direct contact with bony structures,
while the inner layer is in contact with either blood or cerebrospinal fluid.
(15,18)
CAUSES
Carotid-cavernous fistulas (CCFs)...
Findings and procedure details
IMAGING DIAGNOSIS
CCF is a rare and difficult to diagnosis disease.
A few techniques may be used to diagnose this condition such as ultrasonography (US),
computed tomography (CT),
magnetic resonance imaging (MRI) and digital substraction angiography (DSA).
COMPUTED TOMOGRAPHY (CT)
Represents a non-invasive cross-sectional image modality that can be an useful tool in the early diagnosis of these arteriovenous fistulas.(9) It can detect dilatation or thrombosis of the superior ophthalmic vein (SOV),
edema of the periorbital fat and thickening of the extraocular muscles.
Postcontrast phase...
Conclusion
CCFs represent a rare and serious disorder that may determine grave consequences,
therefore we consider that young radiologists should be informed about all the imaging methods helpful for the diagnosis of this disease including ultrasonography.
This technique represents a safe and fast method that is well suited for the diagnosis,
postinterventional outcome and further follow-up of patients as it avoids the invasive nature of methods such as angiography.
Although DSA remains the gold standard for the final evaluation and treatment of CCFs,
CDI represents a...
References
REFERENCES
1.
Bora K,
Burak K,
Ercan T,
Civan I,
Naci K,
Osman K.
Endovascular treatment of carotid cavernous sinus fistula: A systematic review.
World J Radiol 2013 April 28; 5(4): 143-155
2.
Yu-Wei C; Jiann-Shing J; Hon-Man L; Bao-Show H; Win-Hwan L; Ping-Keung Y.
Carotid and Transcranial Color-Coded Duplex Sonography in Different Types of Carotid-Cavernous Fistula.
Stroke.
2000;31:701-706
3.
Duan Y,
Liu X,
Zhou X,
Cao T,
Ruan L,
Zhao Y.
Diagnosis and Follow-up Study of Carotid Cavernous Fistulas With Color Doppler Ultrasonography. Journal...