• Seon-Kyu Lee, Robert A Willinsky, Walter Montanera, and Karel G terBrugge.
• Department of Medical Imaging, Division of Neuro-imaging, University of Toronto, Toronto Western Hospital, Ontario, Canada.
• AJNR Am J Neuroradiol. 2003 Sep 1;24(8):1602-6.

Background And PurposeRetrograde leptomeningeal venous drainage (RLVD) in a dural arteriovenous fistula (DAVF) is associated with intracerebral hemorrhage, nonhemorrhagic neurologic deficit, or death, and recognizing the presence of this drainage is important. We investigated the MR findings of DAVFs draining into cerebellar cortical veins and compared these findings with those of conventional angiography.MethodsThe MR and angiographic findings of six patients (five men, one woman; mean age, 73.4 years) with DAVF with RLVD into cerebellar cortical veins were reviewed retrospectively. Signal intensity characteristics, contrast material enhancement, topography of the lesion, and presence of signal voids were evaluated on MR images. Site of the shunt, feeding arteries, and draining veins were evaluated on angiograms.ResultsIn all patients, MR images showed high signal intensity on T2-weighted images and peripheral enhancement on gadolinium-enhanced T1-weighted images at the inferior aspect of the cerebellar hemisphere. A combination of posterior meningeal and occipital arteries was the most frequent blood supply (83%) for these DAVFs. In all six patients, the inferior hemispheric vein was the primary draining vein.ConclusionThe characteristic MR findings of DAVF draining into cerebellar cortical veins represent venous congestive encephalopathy in the territory of the involved cortical vein.

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