Open AccessJugular Venous Reflux Can Mimic Posterior Fossa Dural Arteriovenous Fistulas on MRI-MRA
Author(s) -
M Travis Caton,
Andrew L. Callen,
Alexander Copelan,
Kazim Narsinh,
Eric R Smith,
Matthew R Amans
Publication year - 2021
Publication title -
american journal of roentgenology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.294
H-Index - 196
eISSN - 1546-3141
pISSN - 0361-803X
DOI - 10.2214/ajr.20.24012
Subject(s) - medicine , radiology , skull , posterior fossa , arteriovenous malformation , arteriovenous fistula , cerebral veins , jugular vein , angiography , shunting , magnetic resonance imaging , surgery
Dural arteriovenous fistulas (DAVFs) are high-flow acquired shunts that can carry high risk of intracranial hemorrhage. Because DAVFs can often be managed by endovascular means, early and accurate diagnosis can markedly improve patient morbidity. Time-of-flight and arterial spin-labeling MRA have increased the diagnostic utility of MRI for DAVF by showing hemodynamic rather than anatomic evidence of shunting. The purpose of this article is to describe the cases of seven patients who had co-localization of arterial spin-labeling signal intensity and time-of-flight flow-related enhancement in the left skull base, resulting in a misdiagnosis of DAVF and a recommendation for catheter angiography by the interpreting radiologist. Benign jugular venous reflux is identified as a common mechanism in each case, and the physiology behind this imaging pitfall is described. An algorithmic diagnostic approach to differentiating physiologic venous reflux from true posterior skull base DAVFs is presented.