Efficacy of High-Resolution Cone-Beam CT for the Endovascular Treatment of Dural Arteriovenous Fistulas.

Purpose: The analysis of the microstructure of dural arteriovenous fistulas (DAVFs) plays a crucial role in achieving the successful embolization of DAVFs associated with complex microanatomy. Recent advancements in high-resolution cone-beam computed tomography (CBCT) enable detailed visualizations of the microstructure of the shunt point. In this study, we retrospectively evaluated the efficacy of this imaging modality in terms of the clinical and angiographic outcomes of the endovascular approach.

Methods: We retrospectively analyzed a total of 83 cases of dural arteriovenous fistulas (AVFs), including spinal lesions. High-resolution CBCT images with an 8-inch field of view and 1024 × 1024 pixel matrix detector at 80 kV were acquired. The anatomical variation and configuration of DAVFs were analyzed and compared with superselective angiography findings.

Results: The sensitivity of the shunt location was over 96.3%, and the tip of the microcatheter in the affected sinus was well visualized during the procedure. In particular, this imaging modality was effective in identifying the exact shunt point in relation to the initial foot of the vein in cases of spinal and spinal epidural DAVFs. The quality of the images depended on the regional concentration of the contrast and the timing of acquisition. The arrival time of the contrast to the objects was an important factor in visualizing the microanatomical structure.

Conclusion: Appropriately adjusted CBCT acquisition parameters are sufficient to visualize the microanatomy of lesions and adjacent structures and sufficient to identify the shunt point, even in cases of complex DAVFs.