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The Use of Susceptibility-Weighted Imaging as an Indicator of Retrograde Leptomeningeal Venous Drainage and Venous Congestion With Dural Arteriovenous Fistula: Diagnosis and Follow-up After Treatment

Nakagawa, Ichiro MD, PhD*; Taoka, Toshiaki MD, PhD; Wada, Takeshi MD; Nakagawa, Hiroyuki MD, PhD§; Sakamoto, Masahiko MD, PhD; Kichikawa, Kimihiko MD, PhD; Hironaka, Yasuo MD*; Motoyama, Yasushi MD, PhD*; Park, Young-Su MD, PhD*; Nakase, Hiroyuki MD, PhD*

doi: 10.1227/NEU.0b013e318276f7cc
Research-Human-Clinical Studies

BACKGROUND: Retrograde leptomeningeal venous drainage (RLVD) in dural arteriovenous fistulas (DAVFs) is associated with intracerebral hemorrhage and nonhemorrhagic neurological deficits or death. Angiographic evidence of RLVD is a definite indication for treatment, but less invasive methods of identifying RLVD are required.

OBJECTIVE: To evaluate the efficacy of susceptibility-weighted magnetic resonance imaging (SWI) in detecting RLVD in DAVFs.

METHODS: We retrospectively identified 17 DAVF patients who had angiographic evidence of RLVD and received treatment. Conventional angiography and SWI were assessed at pretreatment and posttreatment time points. The presence of RLVD on SWI was defined as cortical venous hyperintensity, and the presence of venous congestion on SWI venograms was defined as increased caliber of cortical or medullary veins.

RESULTS: Cortical venous hyperintensity was identified in pretreatment SWI of 15 patients. Cortical venous hyperintensity was absent in early posttreatment SWI, consistent with the absence of RLVD in posttreatment angiography, in all but one of these patients. In 2 patients, cortical venous hyperintensity was identified during follow-up, indicating the recurrence of RLVD. Cortical venous hyperintensity was not identified in the pretreatment SWI of 2 patients despite angiographic evidence of RLVD. Venous congestion was identified in pretreatment SWI venograms of 11 patients and had an appearance similar to that identified from angiography. Venous congestive signs improved over the follow-up period.

CONCLUSION: The presence of SWI hyperintensity within the venous structure could be a useful indicator of RLVD in DAVF patients. Thus, SWI offers a noninvasive alternative to angiography for the identification of RLVD in pretreated and posttreated DAVF patients.

ABBREVIATIONS: DAVF, dural arteriovenous fistulas

DSA, digital subtraction angiography

RLVD, retrograde leptomeningeal venous drainage

SWI, susceptibility-weighted magnetic resonance imaging

TAE, transarterial embolization

TVE, transvenous embolization

*Department of Neurosurgery and

Department of Radiology, Nara Medical University, Nara, Japan

§Department of Radiology, Nara Prefectural Hospital, Nara, Japan

Correspondence: Ichiro Nakagawa, MD, PhD, Department of Neurosurgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan. E-mail:

Received April 18, 2012

Accepted September 25, 2012

Copyright © by the Congress of Neurological Surgeons