Multidetector CT angiography in the diagnosis and classification of carotid-cavernous fistula
Insights
Multidetector computed tomography angiography (MDCTA) effectively identifies carotid-cavernous fistulas (CCFs) using engorgement and enhancement patterns. Specific findings like dehiscent internal carotid artery (ICA) significantly aid in classifying direct CCFs.
Area of Science:
- Radiology
- Neuroimaging
- Vascular Imaging
Background:
- Carotid-cavernous fistulas (CCFs) are abnormal connections between the carotid artery and the cavernous sinus.
- Accurate diagnosis and classification are crucial for effective treatment planning.
Purpose of the Study:
- To assess the diagnostic performance of multidetector computed tomography angiography (MDCTA) in identifying and classifying CCFs.
- To evaluate specific imaging findings indicative of CCFs and their subtypes.
Main Methods:
- Retrospective analysis of MDCTA images from 34 patients with CCFs and 18 controls.
- Evaluation of four key findings: ophthalmic vein engorgement, cavernous sinus engorgement, similar cavernous sinus and internal carotid artery enhancement, and cavernous sinus versus transverse sinus enhancement.
- Assessment of dehiscent internal carotid artery for direct CCF identification.
Main Results:
- MDCTA demonstrated high sensitivity and specificity for identifying CCFs based on engorgement and enhancement patterns.
- Excellent inter-reader agreement was observed for all evaluated findings (κ > 0.80).
- Dehiscent internal carotid artery showed high sensitivity (100%) and specificity (75-88%) for direct CCF classification. Significant differences in vessel attenuation values were noted between CCF patients and controls.
Conclusions:
- MDCTA is a valuable tool for diagnosing CCFs, with engorgement and enhancement patterns showing comparable performance.
- Measurements of vessel attenuation differences provide high diagnostic value.
- Identifying a dehiscent internal carotid artery is highly beneficial for classifying direct CCFs.
Aim:
To evaluate the performance of multidetector computed tomography angiography (MDCTA) in identifying and classifying carotid-cavernous fistulas (CCFs).
Materials And Methods:
The neuro-interventional database was searched for patients with CCFs at four different institutions and for normal controls at one of the four institutions. Thirty-four patients were divided into the case group (direct type, n=8; indirect type, n=8) and the control group (n=18). Two readers retrospectively evaluated thin-section CTA images for the presence and laterality of four findings: (1) engorged ophthalmic vein, (2) engorged cavernous sinus, (3) similar enhancement of the cavernous sinus (CS) and internal carotid artery (ICA), and (4) greater enhancement of the CS than the transverse sinus (TS). Dehiscent ICA for the direct type was assessed only in the case group. Sensitivity, specificity, and inter-reader agreement were determined. Attenuation differences between the ICA and CS and between the CS and TS were compared across groups.
Results:
The sensitivity/specificity for two engorgement and two enhancement findings were 81%/100%, 88%/94%, 100%/100%, and 88%/100%, respectively, for Reader 1, and 75%/100%, 75%/100%, 88%/100%, and 88%/100%, respectively, for Reader 2. Agreement between readers was excellent for all findings (κ>0.80). Dehiscent ICA identified the direct type with a sensitivity/specificity of 100%/75% for Reader 1 and 100%/88% for Reader 2 (κ=0.871). In the case group, the difference between ICA and CS attenuation values was significantly lower (180.1±76.6 versus 7.5±23.7; ⤳<0.001) and that between CS and TS were higher (-31.2±69 versus 102.6±59.3; ⤳<0.001). The area under the curve for the latter values was 0.95.
Conclusion:
The engorgement and enhancement categories in MDCTA may perform comparably in identifying CCFs and measurements of vessel attenuation differences may be of high diagnostic value. Dehiscent ICA can greatly aid in identifying the direct type.
Related Concept Videos
01:28Imaging Studies for Cardiovascular System V: CT
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:21Aneurysm II: Clinical Manifestations and Diagnostic Studies
01:30Acute Coronary Syndrome III: Diagnostic Studies