3-DIMENSIONAL FISP IMAGING IN THE EVALUATION OF CAROTID-CAVERNOUS FISTULA - COMPARISON WITH CONTRAST-ENHANCED CT AND SPIN-ECHO MR

PURPOSE: The purpose of this study was to assess the value of three-di mensional fast imaging with steady-state precession (FISP) MR sequence s relative to contrast-enhanced CT and spin-echo MR imaging in the dia gnosis of carotid cavernous fistula (CCF), METHODS: Seventeen patients with 19 angiographically proved CCFs had contrast-enhanced CT, spin-e cho MR imaging, and 3-D FISP imaging. Three observers assessed these i maging studies as well as those of 43 control sides in a blinded manne r for the presence or absence of CCF, Receiver operating characteristi c analysis was used to assess the diagnostic utility of each imaging t echnique. In a nonblinded study, contrast-enhanced 3-D FISP images wer e also evaluated, RESULTS: Higher diagnostic accuracy was obtained wit h 3-D FISP sequences, as the shunt flow within the cavernous sinus was well seen, Sensitivity of 3-D FISP images was 83% and specificity was 100% in the blinded study, In the receiver operating characteristic a nalysis, the diagnostic performance of observers was found to be bette r with the 3-D FISP images than with the spin-echo MR images. Although there were no significant difference between 3-D FISP and contrast-en hanced CT, higher diagnostic performance was obtained with 3-D FISP im ages, In three CCFs without anterior drainage, a diagnosis was made on ly from the 3-D FISP images, The contrast-enhanced 3-D FISP images wer e not helpful, since the cavernous sinuses enhanced. CONCLUSION: Three -dimensional FISP imaging is superior to spin-echo MR imaging and cont rast-enhanced CT in the diagnosis of CCF. Contrast-enhanced 3-D FISP i mages are not helpful for the evaluation of CCF.