Validity of Carotid Duplex Sonography in Screening for Intracranial Dural Arteriovenous Fistula among Patients with Pulsatile Tinnitus

Abstract

Pulsatile tinnitus may result from intracranial dural arteriovenous fistula (DAVF), which requires early diagnosis and management. This study validated the role of carotid duplex sonography in screening for DAVF in patients with pulsatile tinnitus. The criteria used for DAVF screening were low resistance index of the external carotid artery or occipital artery (OA). Patients then underwent head magnetic resonance imaging to confirm the diagnosis. Of the 155 patients with pulsatile tinnitus who were prospectively screened, 25 (16.1%) had a low resistance index in either the external carotid artery or occipital artery. All were proven to have DAVF. The diagnostic sensitivity, specificity, positive predictive value and negative predictive value were 96%, 100%, 100% and 98%, respectively. Thus, carotid duplex sonography focusing on low resistance indexes of the external carotid and occipital arteries may be a valuable tool in screening for DAVF in patients with pulsatile tinnitus.

Keywords: Carotid duplex sonography; Dural arteriovenous fistula; Pulsatile tinnitus; Screening; Stroke.