Background and purpose Engorged medullary vein (EMV) in patients with intracranial dural arteriovenous fistula (DAVF) suggests venous congestion. The aim of this study is to investigate its prevalence, pattern, and correlation with clinical findings.
Materials and methods CT angiography (CTA) raw data of DAVF were used for multiplanar reconstruction and then analyzed for the presence and pattern of EMV, which is defined as a dilated vein in the cerebral white matter. Patients with EMV were divided into two groups: regional and extensive. Regional type is defined as EMV limited to one cerebral hemisphere or cerebellum without evidence of subcortical calcification. Extensive type is defined as EMV involvement of more than one cerebral hemisphere or both the cerebrum and cerebellum. Descriptive analysis of clinical information, DAVF characteristics, and other imaging findings was conducted. Clinical information, including demographic data, clinical presentation, and hemorrhage, were correlated with both types of EMV.
Results Among 192 eligible patients with DAVF, 71 (37%) had EMV. Patients with EMV were older (63 years vs 56 years, P=0.02), with DAVF more often at the transverse and sigmoid sinus (P<0.001), and more often presented with aggressive symptoms (59% vs 34%, P=0.02) than non-EMV patients, but there was no difference in the presentation of hemorrhage (15% vs 16%, P=0.99). Patients with regional EMV had a higher proportion of hemorrhage than those with the extensive type (24% vs 0%, P=0.006).
Conclusions EMV in patients with DAVF is associated with an aggressive manifestation. Regional type EMV is associated with a higher risk of a hemorrhagic presentation.
- arteriovenous malformation
- CT angiography
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Contributors YHL, CWL, YFW, CJL, YFC, and HML made (1) substantial contributions to the conception or design of the work or the acquisition, analysis or interpretation of data for the work; (2) drafting of the work or revising it critically for important intellectual content; (3) final approval of the version to be published; and (4) are in agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.
Ethics approval IRB of National Taiwan University Hospital.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Data can be made available by contacting the corresponding author via email.