Foo SY, Swaminathan SK, Krings T. Dilated MMA sign in cDAVF and other arterial feeders on 3D TOF MRA.
Neuroradiol J 2021;
35:290-299. [PMID:
34449286 PMCID:
PMC9244742 DOI:
10.1177/19714009211041530]
[Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background
Among the varied causes of pulsatile tinnitus, the condition that can cause
severe mortality and morbidity is a cranial dural arteriovenous fistula
(cDAVF). This study aimed to assess the diagnostic accuracy of the dilated
middle meningeal artery on three-dimensional time-of-flight magnetic
resonance angiography in cranial dural arteriovenous fistula and to identify
other feeders that can aid in the detection of these lesions.
Method
Magnetic resonance angiography and digital subtraction angiography data of
all patients with cranial dural arteriovenous fistula treated in a single
tertiary referral center between 2007–2020 were included. The middle
meningeal artery and other feeders recorded from digital subtraction
angiography were assessed on magnetic resonance angiography.
Results
The overall agreement between readers in identifying the dilated middle
meningeal artery was substantial (κ = 0.878, 95% confidence interval:
0.775–0.982). The dilated middle meningeal artery indicated the presence of
a cranial dural arteriovenous fistula with a sensitivity of 79.49% (95%
confidence interval: 66.81–92.16), specificity of 100% (95% confidence
interval: 100.00–100.00), and negative predictive value of 94.56% (95%
confidence interval: 90.89–98.02). An area under the curve of 0.8341 was
observed for the ipsilateral middle meningeal artery, with a sensitivity of
92.2% and a specificity of 75.0% at a cut-off of 0.30 mm for identifying a
cranial dural arteriovenous fistula. Of 73 other feeders, the occipital,
meningohypophyseal trunk, ascending pharyngeal, and posterior meningeal
arteries contributed to a large proportion visualized on magnetic resonance
angiography (83.6% (41/49)).
Conclusion
The dilated middle meningeal artery sign is useful for identifying a cranial
dural arteriovenous fistula. Dilatation of the occipital and ascending
pharyngeal arteries and meningohypophyseal trunk should be assessed to
facilitate the detection of a cranial dural arteriovenous fistula,
particularly in the transverse-sigmoid and petrous regions.
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