Keywords:
Interventional vascular, Neuroradiology brain, Catheter arteriography, Embolisation, Arteriovenous malformations
Authors:
H. Kiyosue1, S. Tanoue1, J. Kashiwagi2, H. Mori2; 1YUFU/JP, 2Oita/JP
DOI:
10.1594/ecr2013/C-2570
Methods and Materials
We retrospectively analyzed 15 consecutive patients with intracranial DAVFs who underwent rotational cerebral angiography and were subsequently treated between August 2010 and November 2012.
Characteristics of the 15 patients were summarized in table 1.
The patients’ ages ranged from 41 to 80 years (mean age,
63 years),
and there were 9 males and 6 females.
In one patient with transverse-sigmoid sinus (TSS) DAVFs,
another DAVFs developed at the superior sagittal sinus after the TSS DAVFS cured by transvenous embolization during this period.
Therefore,
16DAVFs were reviewed in this study.
The DAVFs were located at the TSS (n=10),
the cavernous sinus (n=2),
the superior petrosal sinus (n=1),
the superior sagittal sinus (n=1),
tentorium (n=1),
and anterior cranial fossa (n=1).
There were 3 type I DAVFs,
2 type IIa DAVFs,
3 type IIa+b DAVFs,
6 type IIb DAVFs,
and 2 type II DAVFs according to Cognard’s classification of venous drainage of the DAVFs (2).
Three lesions were treated by transarterial emboization with glue,
and 7 lesions were treated by transvenous embolization of sinus packing (n=3) or selective embolization of the shunted pouches (n=4).
The 5 lesions were treated by selective transvenous embolization combined with transarterial embolization with diluted NBCA-lipiodol mixture.
The remaining 1 patient with type 1 TSSDAVFs was followed without treatment.
Biplane selective digital subtraction angiography (DSA) of bilateral internal and external carotid arteries and the vertebral arteries were performed in all patients using biplane angiography equipment (Infinix VB,
Toshiba Medical,
Tokyo).
Rotational DSA was performed when AVFs were found on biplane selective angiography of each cerebral artery.
The rotational angle was 200°,
and the rotational speed of the C-arm was 50°/second.
Data were acquired in a 512 × 512 matrix using an 8-inch field-of-view flat panel detector. A nonionic iodinated contrast material (iopamidol,
Iopamiron 300; Bayel HealthCare Japan,
Osaka) was injected at a flow rate of 1.5-3.5 mL/sec (14-24.5 mL of total volume) through an automatic injector,
and the injection was initiated 1.5-2.0 seconds before the rotation.
Three-dimensional (3D) images were reconsructed from a data set of rotational angiography using a workstation (Advantage Workstation,
GE Healthcare Milwaukee; Ziostation,
Ziosoft,
Tokyo).
3D vascular images (3D-DSA) were also reconstructed from a rotational DSA data set built by subtracting mask images from the contrast images.
Then,
3D fusion angiographic images were obtained by fusing the 3D-digital angiography (nonsubtracted) and 3D-DSA data sets using the same workstation without registration operation within 5 seconds (Fig.
1).
Three types of reconstructed images of maximum intensity projection and volume rendering reconstruction,
MPR images can be available.
All angiographic images and partial MIP and MPR images of 3D digital angiography and 3D fusion angiography were reviewed by two experienced neuroradiologists (H.K.
and S.T.) with consensus.
Selective venography during transvenous embolization was also reviewed when available.
The visualization of angioarchitectures of DAVFs including feeding arteries,
shunted pouches and draining veins was comparatively evaluated between 3D digital angiography and 3D fusion angiography.
A shunted pouch was defined as a tubular or elliptical vascular structure that is separated from the main sinus lumen into which multiple feeding arteries converge and that continues to main sinus lumen.
Institutional review board approval is not required for such a retrospective study at our institution.