Arterial spin labelling could detect the occlusion of inferior petrosal sinus for cavernous sinus dural arteriovenous fistula

Several reports indicate that arterial spin labelling (ASL) MRI is useful for the diagnosis, identification of cortical venous reflux, and assessment of therapeutic effect in dural arteriovenous fistula (dAVF). However, there is no reports indicating the utility of ASL in the identification of venous sinus obstruction. We herein report the case of a 72-year-old woman who presented with diplopia and right trigeminal neuralgia due to bilateral cavernous sinus dAVF. Digital subtraction angiography (DSA) showed temporal occlusion of the inferior petrosal sinus (IPS) and ASL indicated hyperintense signal in the IPS. The ASL signal could indicate venous stasis soon after the occlusion based on the serial changes of IPS patency and occlusion observed in the DSA.