Figure 6:

A 80-year-old woman presents with diplopia, dizziness, and incoordination. Conventional MR imaging was unremarkable. PCASL demonstrates a markedly hyperintense signal within the left cavernous sinus and superior ophthalmic vein, SOV (a, left column). Time-of-flight MRA shows only subtle flow-related enhancement within the left SOV (a, right column). Suspicion of cavernous-carotid fistula was raised based on the ASL perfusion maps. Conventional angiography confirms the diagnosis and shows early venous drainage into the left cavernous sinus and SOV on arterial (b, top) and parenchymal (b, bottom) phase imaging (b, red arrow).