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: We included 63 DAVF patients and 170 non-DAVF patients who received both CDS and conventional angiography. We validated the use of seven CDS hemodynamic parameter sets related to the resistance index (RI) of the external carotid artery (ECA) for the diagnosis of DAVF and tested the applicability of the best CDS parameter set in 20,400 patients.
Results: The CDS parameter set (ECA RI [cutoff point = 0.7] and internal carotid artery (ICA)-to-ECA RI ratio [cutoff 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 the 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 tumor (n = 3), and unknown etiology (n = 19).
Conclusion: Combined CDS parameters of (ECA RI) and (ICA-to-ECA RI ratio) can be used as a screen tool for diagnosis of DAVF.