Purpose

Intracranial lateral dural arteriovenous fistula (LDAVF) represents a specific subtype of cerebrovascular fistulae, harboring a potentially life-threatening risk of brain hemorrhage. Fluoroscopically guided endovascular embolization is the therapeutic gold standard. We provide detailed dosimetry data to suggest novel diagnostic reference levels (DRL).

Methods

Retrospective single-center study of LDAVFs treated between January 2014 and December 2019. Regarding dosimetry, the dose area product (DAP) and fluoroscopy time were analyzed for the following variables: Cognard scale grade, endovascular technique, angiographic outcome, and digital subtraction angiography (DSA) protocol.

Results

A total of 70 patients (19 female, median age 65 years) were included. Total median values for DAP and fluoroscopy time were 325 Gy cm² (25%/75% percentile: 245/414 Gy cm²) and 110 min (68/142min), respectively. Neither median DAP nor fluoroscopy time were significantly different when comparing low-grade with high-grade LDAVF (Cognard I + IIa versus IIb–V; p > 0.05, each). Transvenous coil embolization yielded the lowest dosimetry values, with significantly lower median values when compared to a combined transarterial/transvenous technique (DAP 290 Gy cm² versus 388 Gy cm², p = 0.031; fluoroscopy time 85 min versus 170 min, p = 0.016). A significant positive correlation was found between number of arterial feeders treated by liquid embolization and both DAP (r_s = 0.367; p = 0.010) and fluoroscopy time (rs = 0.295; p = 0.040). Complete LDAVF occlusion was associated with transvenous coiling (p = 0.001). A low-dose DSA protocol yielded a 20% reduction of DAP (p = 0.021).

Conclusion

This LDAVF study suggests several local DRLs which varied substantially dependent on the endovascular technique and DSA protocol.

中文翻译：

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颅内硬脑膜外侧动静脉瘘患者血管内治疗的放射剂量和透视时间

目的

颅内硬脑膜外侧动静脉瘘 (LDAVF) 是脑血管瘘的一种特殊亚型，具有潜在的危及生命的脑出血风险。荧光镜引导血管内栓塞是治疗的金标准。我们提供详细的剂量学数据以建议新的诊断参考水平 (DRL)。

方法

对 2014 年 1 月至 2019 年 12 月期间治疗的 LDAVF 进行的回顾性单中心研究。关于剂量学，分析了剂量面积乘积 (DAP) 和透视时间的以下变量：Cognard 量表分级、血管内技术、血管造影结果和数字减影血管造影 ( DSA) 协议。

结果

共纳入 70 名患者（19 名女性，中位年龄 65 岁）。DAP 和透视时间的总中值分别为 325 Gy cm ²（25%/75% 百分位数：245/414 Gy cm ²）和 110 分钟（68/142 分钟）。在比较低级别和高级别 LDAVF 时，中位 DAP 和透视时间均无显着差异（Cognard I + IIa 与 IIb-V；每个p  > 0.05）。与经动脉/经静脉联合技术相比，经静脉线圈栓塞产生的剂量测定值最低，中值显着降低（DAP 290 Gy cm ²对 388 Gy cm ²，p  = 0.031；透视时间 85 分钟对 170 分钟，p = 0.016)。_{液体栓塞治疗的动脉供血器数量与}DAP (rs  = 0.367; p  = 0.010) 和透视时间 (rs = 0.295; p  = 0.040)之间存在显着的正相关。完全 LDAVF 闭塞与经静脉栓塞相关 ( p  = 0.001)。低剂量 DSA 方案使 DAP 减少了 20% ( p  = 0.021)。

结论

这项 LDAVF 研究提出了几个局部 DRL，它们在很大程度上取决于血管内技术和 DSA 协议。