Screen for intracranial dural arteriovenous fistulae with carotid duplex sonography
- 1Department of Neurology and Stroke Centre, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- 2Department of Radiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Correspondence to Professor J-S Jeng, Department of Neurology, National Taiwan University Hospital, No 7 Chung-Shan South Road, Taipei 100, Taiwan; jsjeng{at}ntu.edu.tw
- Received 27 October 2008
- Revised 4 February 2009
- Accepted 5 February 2009
- Published Online First 29 March 2009
Abstract
Objectives: Early diagnosis and management of intracranial dural arteriovenous fistulae (DAVF) may prevent the occurrence of stroke. This study aimed to identify the best carotid duplex sonography (CDS) parameters for screening DAVF.
Methods: 63 DAVF patients and 170 non-DAVF patients received both CDS and conventional angiography. The use of seven CDS haemodynamic parameter sets related to the resistance index (RI) of the external carotid artery (ECA) for the diagnosis of DAVF was validated and the applicability of the best CDS parameter set in 20 400 patients was tested.
Results: The CDS parameter set (ECA RI (cut-off point = 0.7) and internal carotid artery (ICA) to ECA RI ratio (cut-off point = 0.9)) had the highest specificity (99%) for diagnosis of DAVF with moderate sensitivity (51%). Location of the DAVF was a significant determinant of sensitivity of detection, which was 70% for non-cavernous DAVF and 0% for cavernous sinus DAVF (p<0.001). The above parameter set detected abnormality in 92 of 20 400 patients. These abnormalities included DAVF (n = 25), carotid stenosis (n = 32), vertebral artery stenosis (n = 7), intracranial arterial stenosis (n = 6), head and neck tumour (n = 3) and unknown aetiology (n = 19).
Conclusion: Combined CDS parameters of ECA RI and ICA to ECA RI ratio can be used as a screening tool for the diagnosis of DAVF.
Footnotes
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Competing interests None.
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Ethics approval The study was approved by the ethics committee of the National Taiwan University Hospital (IRB No 200812095R).
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Provenance and Peer review Not commissioned; externally peer reviewed.
