The visualization methods of occluded dural sinus for safe transvenous embolization of dural AVFs

Abstract Background Transvenous embolization (TVE) via occluded sinus is one option for the treatment of dural arteriovenous fistulas (dAVFs). Understanding of the anatomical characteristics of the occluded sinus is difficult. It is often hard to reach the shunt point due to some risk of vessel perforation. Methods We assessed usefulness of T1 Volumetric Isotropic TSE Acquisition (VISTA) Black Blood (BB) and 3D-T1 Fast Field Echo (FFE) for the evaluation and visualization of an occluded sinus. Evaluation of T1 VISTA BB and 3D-T1 FFE were performed preoperatively. TVE was performed via the occluded sinus while referring to the visualized reconstruction image. Results Fourteen cases of TVE were performed between 2009 and 2015. The entire occluded sinus, including both thrombus and blood flow, was seen as high intensity region on 3D FFE T1Gd. On the other hand, thrombus was seen as iso- or high-intensity region and blood flow as low intensity region on T1VISTA BB. The maximum intensity projection (MIP) reconstruction image of 3D FFE T1Gd could visualized whole occluded sinus and useful for microcatheter maneuver. Total shunt obliteration was achieved in 13 cases (92.8%) except for one. Conclusions MRI evaluation of the occluded sinus using both T1 VISTA BB and 3D FFE T1Gd give us valuable information of the occluded sinus regarding the development and the course of the occluded sinus, the length of the thrombotic occlusion, and leads to safer catheter maneuvers in transvenous embolization.