MRI OF THE BRAIN AND SKULL BASE WITH MRA OF BRAIN AND NECK:
History: Rule out DAVF at the left eye.
Technique: Sagittal T1W; Axial T1W, T2W, FLAIR, DWI/ADC; Coronal GRET2; Thin slice axial & coronal SE T1W FS-/+Gd, FSE T2W FS at base of skull; 3D TOF and contrasted MRA.
Findings:
The study shows normal brain parenchyma, cortical sulci and ventricular system. No exophthalmos is detected.
No definite infarct, intracerebral hemorrhage, extra-axial collection, hydrocephalus, midline shift or brain herniation is seen.
There is bulging left cavernous sinus contains multiple flow voids at posterior left cavernous sinus. The right cavernous sinus is unremarkable. The internal carotid arteries are within normal limits.
The bony orbit, optic nerves and orbital globe appear unremarkable. There is no definite mass or compressive lesion.
The MRA study shows abnormal arterialized flow at left cavernous sinus. Retrograde reflux to left superficial middle cerebral vein and antegrade reflux to retroclival venous plexus are seen. Also noted is suspected reflux into left supretrosal venous sinus. No reflux to ophthalmic veins or cortical vein is detected. The rest of dural venous systems are unremarkable. The intracranial and cervical carotid and vertebrobasilar systems appear unremarkable.
The paranasal sinuses, mastoid air cells and nasopharynx is unremarkable.
Impression:
- Suggestive of left cavernous dural AVF without cortical venous reflux
- No intracranial hemorrhage, hydrocephalus or brain herniation
- Otherwise, unremarkable
Pat S. Kwankaew, MD