Joint Annual Meeting 2018: Swiss Society of Neurosurgery (SSNS), Swiss Society of Neuroradiology (SSNR), IG-NOPPS
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Paper title High-Resolution Vessel Wall MRI in Ruptured Cranial Dural Arteriovenous Fistulas
Paper code P46
Authors
  1. Samuel Sommaruga Geneva University Hospitals (HUG) Speaker
  2. Branden Cord Yale University School of Medicine Speaker
  3. Corrado Santarosa Geneva University Hospital
  4. Jacky Yeung Yale University School of Medicine
  5. Michele H. Johnson Yale University School of Medicine
  6. Ryan Hebert Yale University School of Medicine
  7. Philippe Bijlenga Hôpitaux Universitaires Genève (HUG)
  8. Karl Schaller HUG Hôpitaux Universitaires Genève
  9. Charles Matouk Yale University School of Medicine
Form of presentation Poster
Topics
  • Joint SSNR | SSNS
Abstract text Aims:
High-resolution MR vessel wall imaging (MR-VWI) is increasingly being used to characterize intracranial vascular diseases, specifically, we have demonstrated its utility in identifying the site of rupture in aneurysmal SAH. Here we report our preliminary experience in using MR-VWI to pin-point the site of hemorrhage in ruptured intracranial dural arteriovenous fistulas (dAVFs).

Methods:
A series of seven successive patients presenting to a single institution with ruptured cranial DAVFs underwent classical imaging including non-contrast CT, CT-angiography, and digital subtraction angiography. Additionally, they also underwent high-resolution MR-VWI. Cross-section imaging was correlated with DSA and vascular substructures of each DAVF (i.e. venous varix, fistulas point, associated aneurysms) were evaluated for the presence of vessel wall enhancement and contiguity of hemorrhagic blood products.

Results:
In four of seven patients presenting with ruptured DAVF, high-resolution MR-VWI sequences demonstrated a single focal point of robust vessel wall enhancement that was in immediate contiguity with hemorrhagic blood products. Notably, the vascular substructures demonstrating enhancement are known to be prone to hemorrhage (i.e. venous varix). In patients with multiple high-risk substructures (multiple venous varix and associated aneurysm), only a single structure demonstrated enhancement. In the remaining three patients presenting with ruptured DAVF without macrovascular sub-structures, high-resolution MR-VWI delineated the relationship between the blood product and the arterialized veins, but was insufficient to conclusively identify a site of rupture.

Conclusions:
These cases extend our prior work using MR-VWI to identify the site of rupture in aneurysmal SAH to another intracranial vascular lesion, ruptured DAVFs. They provide proof of principle that the site of rupture in more complex intracranial vascular lesions can be identified by locating the portion of the DAVF that is both contiguous with the hematoma, and demonstrates thick vessel wall enhancement. The accurate identification of the ruptured vascular substructure may inform clinical decision-making.