PURPOSE Previous studies have shown that arterial spin-labeling (ASL) has high sensitivity and specificity for detecting dural arteriovenous fistulas (DAVFs). However, in case of jugular venous reflux (JVR), the labeled protons in the jugular vein may lead to a venous hypersignal in the jugular vein, sigmoid, and transverse sinus on ASL images and mimic DAVF. METHODS To ascertain this hypothesis, two blinded senior neuroradiologists independently and retrospectively reviewed randomized ASL images and graded the likelihood of DAVF on a 5-point Likert scale in 2 groups of patients: (i) 13 patients with angiographically proven type I DAVF; and (ii) 11 patients with typical JVR diagnosed on the basis of clinical and MR imaging data, first using ASL alone, and second using ASL together with all of the sequences including 4D CE MRA. RESULT A dural venous ASL signal was seen in 11 patients with type I DAVF and in all the 11 patients with JVR, with no distinctive pattern between the two. The mean Likert score was "very likely" in DAVF and JVR patients when using ASL alone (k = 0.71), and "very unlikely" for JVR versus "very likely" for DAVF when using all the sequences available (k = 0.92). CONCLUSION Our study shows that JVR can mimic DAVF on ASL images with potential implications for patient care. The detection of DAVFs should be based on additional MR sequences such as TOF-MRA and 4D CE MRA to exclude JVR and to avoid unnecessary DSAs.

中文翻译：

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颈静脉回流可在动脉自旋标记磁共振图像上模拟I型硬脑膜动静脉瘘。

目的先前的研究表明，动脉自旋标记（ASL）对检测硬脑膜动静脉瘘（DAVFs）具有很高的灵敏度和特异性。但是，如果发生颈静脉回流（JVR），则在ASL图像上模拟颈静脉中的标记质子可能会导致颈静脉中的静脉高信号，乙状结肠和横窦，并模拟DAVF。方法为了确定这一假说，两名失明的高级神经放射科医生分别对两组患者进行了回顾性回顾性ASL图像回顾，并以5点李克特量表对DAVF的可能性进行了分级：（i）13例经血管造影证实为I型DAVF的患者；（ii）根据临床和MR影像数据诊断出的11例典型JVR患者，首先单独使用ASL，其次使用ASL及其所有序列，包括4D CE MRA。结果11例I型DAVF患者和11例JVR患者均见到硬脑膜静脉ASL信号，两者之间无明显区别。当单独使用ASL时，DAVF和JVR患者的Likert平均得分是“极有可能”（k = 0.71），使用所有可用序列时，JVR的“极不可能”与DAVF的“非常可能”（k = 0.92）。结论我们的研究表明JVR可以在ASL图像上模仿DAVF，对患者护理具有潜在的影响。DAVF的检测应基于其他MR序列，例如TOF-MRA和4D CE MRA，以排除JVR并避免不必要的DSA。在DAVF和JVR患者中，当单独使用ASL时（k = 0.71），而在使用所有可用序列时（J = 0.92），JVR与DAVF的“非常可能”相比。结论我们的研究表明JVR可以在ASL图像上模仿DAVF，对患者护理具有潜在的影响。DAVF的检测应基于其他MR序列，例如TOF-MRA和4D CE MRA，以排除JVR并避免不必要的DSA。在DAVF和JVR患者中，当单独使用ASL时（k = 0.71），而在使用所有可用序列时（J = 0.92），JVR与DAVF的“非常可能”相比。结论我们的研究表明JVR可以在ASL图像上模仿DAVF，对患者护理具有潜在的影响。DAVF的检测应基于其他MR序列，例如TOF-MRA和4D CE MRA，以排除JVR并避免不必要的DSA。