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Chen Zhou ZH, Hilario A, Salvador Álvarez E, Cárdenas Del Carre AM, Romero Coronado J, Lechuga Vázquez C, Martínez de Aragón A, Ramos González A. The "Hypointense Focal Brain" on susceptibility-weighted imaging as a sign of venous congestion in cranial dural arteriovenous fistulas. Neuroradiol J 2024:19714009241269522. [PMID: 39075737 DOI: 10.1177/19714009241269522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND Cranial dural arteriovenous fistulas (dAVFs) are complex neurovascular malformations accounting for approximately 10%-15% of all intracranial arteriovenous malformations. The objective is to investigate the utility of susceptibility-weighted imaging (SWI) in identifying "hypointense focal brain" as an additional helpful sign of venous congestion in cranial dAVFs. MATERIALS AND METHODS A retrospective review of patients diagnosed with cranial dAVFs between January 2015 and June 2023 was conducted, and SWI was used to identify the "hypointense focal brain" sign within the venous drainage region of the dAVF. The "hypointense focal brain" on SWI was identified as a low-intensity signal within the venous drainage region, indicative of venous congestion. The presence of this imaging sign was assessed by two neuroradiologists and signal intensity measurements were performed to support the presence of the sign. RESULTS The study included six patients with cranial dAVFs exhibiting cortical venous retrograde drainage and the "hypointense focal brain" on SWI. Follow-up imaging post-treatment revealed resolution or improvement of the hypointense signal, confirming its association with venous congestion. Signal intensity measurements further supported the presence of this imaging sign in pre-treatment scans. CONCLUSION The study's findings demonstrate the presence of a reversible "hypointense focal brain" sign on SWI in patients with cranial dAVFs and CVR, which can be useful as an additional imaging sign for venous congestion.
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Affiliation(s)
- Zhao Hui Chen Zhou
- Neuroradiology Section, Department of Radiology, Hospital Universitario 12 de Octubre, Spain
| | - Amaya Hilario
- Neuroradiology Section, Department of Radiology, Hospital Universitario 12 de Octubre, Spain
| | - Elena Salvador Álvarez
- Neuroradiology Section, Department of Radiology, Hospital Universitario 12 de Octubre, Spain
| | | | - Juan Romero Coronado
- Neuroradiology Section, Department of Radiology, Hospital Universitario 12 de Octubre, Spain
| | - Carmen Lechuga Vázquez
- Neuroradiology Section, Department of Radiology, Hospital Universitario 12 de Octubre, Spain
| | - Ana Martínez de Aragón
- Neuroradiology Section, Department of Radiology, Hospital Universitario 12 de Octubre, Spain
| | - Ana Ramos González
- Neuroradiology Section, Department of Radiology, Hospital Universitario 12 de Octubre, Spain
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Kurisu K, Osanai T, Morishima Y, Ito M, Uchino H, Sugiyama T, Fujimura M. Systemic immune-inflammation index in dural arteriovenous fistula: a feasible biomarker reflecting its clinical characteristics. Acta Neurochir (Wien) 2024; 166:180. [PMID: 38627314 DOI: 10.1007/s00701-024-06075-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 04/05/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE The systemic immune-inflammation index (SII), a marker of systemic inflammation, can be calculated using peripheral blood tests. Although the SII has been reported as a feasible biomarker in various cerebrovascular diseases, no studies have explored in dural arteriovenous fistula (DAVF). A retrospective cohort study was performed to test whether the SII reflects the clinical characteristics of DAVF and whether this index could serve as a feasible biomarker. METHODS This study included 28 patients who underwent endovascular treatment (39 sessions) for DAVF between 2014 and 2023. The SII was calculated using the following formula: platelet count multiplied by neutrophil count divided by lymphocyte count. We investigated the correlation between the SII and various clinical characteristics of DAVF, including symptom manifestation, and digital subtraction angiography findings. Additionally, we compared pre- and post-endovascular treatment changes in the SII. RESULTS A significantly higher SII was observed in patients with multiple lesions, clinical symptoms (particularly aggressive symptoms), pseudophelebitic pattern (PPP), and sinus occlusion. Multivariate regression analysis revealed that the presence of symptoms (coefficient 270.9, P = 0.021) and PPP (coefficient 272.4, P = 0.017) were independent factors contributing to SII elevation. Notably, following endovascular treatment, there was a significant decrease in the elevated SII in patients whose symptoms resolved (P = 0.039) and where the DAVF was angiographically cured (P = 0.012). CONCLUSION Elevation of the SII in patients with advanced DAVF and its decrease following endovascular treatment suggests that the SII reflects the disease condition and indicates its potential as a promising biomarker.
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Affiliation(s)
- Kota Kurisu
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
| | - Toshiya Osanai
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Yutaka Morishima
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Masaki Ito
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Haruto Uchino
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Taku Sugiyama
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Miki Fujimura
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
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Bapuraj JR, Chaudhary N, Masood K, Srinivasan A. The Current Role of SWI in Imaging Cerebrovascular Disorders: Susceptible to Further Advances? Semin Roentgenol 2024; 59:165-171. [PMID: 38880515 DOI: 10.1053/j.ro.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 01/31/2024] [Indexed: 06/18/2024]
Affiliation(s)
- Jayapalli Rajiv Bapuraj
- Department of Radiology, Division of Neuroradiology, University of Michigan, University Hospital, Ann Arbor, MI.
| | - Neeraj Chaudhary
- Department of Radiology, Division of Neuroradiology, University of Michigan, University Hospital, Ann Arbor, MI
| | - Kamran Masood
- Department of Radiology, University of Minnesota, Minneapolis, MN
| | - Ashok Srinivasan
- Department of Radiology, Division of Neuroradiology, University of Michigan, University Hospital, Ann Arbor, MI
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Pinna N, Piccoli F, Pileggi M, Cianfoni A. The 'corkscrew' sign: an indirect MRI hint for intracranial venous hypertension. BMJ Case Rep 2023; 16:e258685. [PMID: 38160032 PMCID: PMC10759020 DOI: 10.1136/bcr-2023-258685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Dural arteriovenous fistulas (DAVFs) are intracranial vascular abnormalities in which one or more meningeal arteries shunt into a venous structure, either a cortical vein or a venous sinus, causing cerebral venous hypertension and risk of haemorrhage. Imaging diagnosis and characterisation are of paramount importance to grade the haemorrhagic risk and direct management. Non-invasive vascular neuroimaging might pose a diagnostic suspicion, but invasive catheter digital subtraction angiography (DSA) is usually required. We present the case of a patient with an atypical acute cerebral haemorrhage in which admission imaging with CT angiography (CTA) and MR angiography (MRA) was unremarkable, while advanced morphological MR with susceptibility-weighted imaging (SWI) revealed specific findings suggesting unilateral chronic venous hypertension. Successively, DSA detected a small DAVF that was treated with endovascular embolization. This case report raises awareness on subtle but important conventional imaging findings that suggest the presence of an AV shunt, to avoid misdiagnosis and delayed treatment.
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Affiliation(s)
- Nicola Pinna
- Department of Neuroradiology, Neurocenter of Southern Switzerland - EOC, Lugano, Switzerland
| | - Francesca Piccoli
- Department of Neuroradiology, Neurocenter of Southern Switzerland - EOC, Lugano, Switzerland
| | - Marco Pileggi
- Department of Neuroradiology, Neurocenter of Southern Switzerland - EOC, Lugano, Switzerland
| | - Alessandro Cianfoni
- Department of Neuroradiology, Neurocenter of Southern Switzerland - EOC, Lugano, Switzerland
- Department of Diagnostic and Interventional Neuroradiology, Inselspital University Hospital, Bern, Switzerland
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