Duplex ultrasound of external carotid artery branches for the detection of dural arteriovenous fistulae

To evaluate duplex ultrasonography of external carotid artery branches for the non-invasive diagnosis of dural AV fistulae (DAVFs). A total of 126 patients suffering from pulsatile tinnitus underwent duplex ultrasonography of the cervicocephalic vasculature including external carotid artery branches. DAVFs were identified by increased flow velocity and reduced pulsatility. Patients with ultrasound findings of DAVFs were considered for selective angiography. Of the 23 patients that fulfilled the ultrasound criteria of AV fistula, 5 did not undergo angiography and were excluded from the study. The ultrasound findings of AV fistula were confirmed in all remaining patients (17 DAVFs, 1 extracranial AV fistula). Duplex ultrasound detected a DAVF of the common carotid artery in 29 %, of the external carotid artery in 65 % and of the external carotid artery branches in 100 % of the cases. Duplex ultrasonography of external carotid artery branches improves the non-invasive detection of DAVFs. For the evaluation of the venous drainage, however, selective angiography is necessary.