The 'Shiny and Thick High Heel Sign'

Autor: Inke R. König, Hannes Schacht, Peter Schramm, Claudia Ditz, Alexander Neumann, Johannes Hensler, Jan Küchler
Rok vydání: 2021
Předmět:
Zdroj: Clinical Neuroradiology. 32:465-470
ISSN: 1869-1447
1869-1439
DOI: 10.1007/s00062-021-01036-y
Popis: Purpose Together with the foramen ovale, the middle meningeal artery (MMA) looks like a high heel shoe print on axial time-of-flight magnetic resonance angiography (TOF-MRA) images, with the MMA resembling the heel. Cranial dural arteriovenous fistulas (DAVF) are often fed by the MMA, which can lead to an increase of signal intensity and diameter of this vessel, resulting in a more “shiny” and “thick” high heel print appearance than on the contralateral side. We describe this finding as a novel radiologic sign and provide cut-off values for the ratios of MMA signal intensities and diameters for predicting the presence of a DAVF. Methods A total of 84 TOF-MRA examinations of 44 patients with DAVFs (40 with unilateral MMA feeders, 4 with bilateral feeders) and of 40 patients without DAVFs were included. Diameters and signal intensities of both MMAs were measured by two raters and evaluated using receiver operating characteristic analysis. Results The diameters of feeding and non-feeding MMAs differed significantly, as did the ratios of signal intensities and of diameters of DAVF and control patients (P Conclusion The described sign seems promising for the detection of DAVFs with noncontrast-enhanced MRI. The TOF-MRA source images should be reviewed with special attention to the MMA.
Databáze: OpenAIRE
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