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Published on: June 3, 2021
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.
Insights
Carotid duplex sonography (CDS) effectively screens for intracranial dural arteriovenous fistulae (DAVF). Specific parameters like external carotid artery (ECA) resistance index (RI) and internal carotid artery (ICA) to ECA RI ratio offer high specificity for early DAVF diagnosis.
Area of Science:
- Neuroimaging
- Vascular Neurology
- Diagnostic Ultrasound
Background:
- Intracranial dural arteriovenous fistulae (DAVF) pose a risk of stroke.
- Early diagnosis and management are crucial for preventing neurological deficits.
Purpose of the Study:
- To identify optimal carotid duplex sonography (CDS) parameters for screening DAVF.
- To evaluate the diagnostic performance of selected CDS parameters.
Main Methods:
- Compared CDS and conventional angiography in 63 DAVF and 170 non-DAVF patients.
- Validated seven CDS hemodynamic parameter sets, focusing on external carotid artery (ECA) resistance index (RI).
- Assessed the best CDS parameter set in a large cohort of 20,400 patients.
Main Results:
- A specific CDS parameter set (ECA RI ≤ 0.7 and ICA/ECA RI ratio ≤ 0.9) demonstrated 99% specificity and 51% sensitivity for DAVF detection.
- Detection sensitivity varied by DAVF location (70% for non-cavernous, 0% for cavernous sinus).
- The parameter set identified 92 abnormalities in 20,400 patients, including DAVF, stenosis, and tumors.
Conclusions:
- Combined CDS parameters (ECA RI and ICA/ECA RI ratio) serve as a valuable screening tool for DAVF.
- CDS can aid in the early detection of various cerebrovascular abnormalities.
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.