BACKGROUND AND PURPOSE: Venous drainage patterns are a major determinant of 
clinical outcome in intracranial dural arteriovenous fistula (DAVF) patients. In 
this study, we sought to identify MR imaging finding differences between DAVF 
types classified on the basis of venous drainage patterns.
METHODS: Twenty-seven patients diagnosed as having DAVFs by conventional 
angiography were included. Medical records (n = 27), and MR imaging (n = 27) and 
MR angiography (MRA; n = 11) findings were retrospectively reviewed. MR imaging 
findings included flow void cluster, engorged ophthalmic vein/proptosis, white 
matter hyperintensity, intracranial hemorrhage, dilated leptomeningeal or 
medullary vessels, venous pouch, and leptomeningeal or medullary vascular 
enhancements. MRA findings included identifiable fistula, venous flow-related 
enhancement, and prominent extracranial vessels. Patients' presentations and MR 
imaging findings were compared among angiographic type I, II, and III cases 
(according to Borden's classification), and MRA findings were compared between 
cases with and without retrograde leptomeningeal venous drainage (RLVD).
RESULTS: Patient presentations were aggressive in one (13%) of the type I cases, 
5 (50%) of the type II cases, and 8 (100%) of the type III cases (P = .002). 
Aggressive presentations included hemorrhage, focal neurologic deficits, 
seizures, intracranial hypertension, and an altered mental status. MR images 
showed significantly higher frequencies of dilated leptomeningeal or medullary 
vessels in a higher type [0 in type I, 5 (42%) in type II, and 7 (100%) in type 
III], and of leptomeningeal or medullary vascular enhancements [0 in type I, 4 
(33%) in type II, and 7 (100%) in type III]. By using MRA, fistulas were 
identified only in cases with RLVD (5 [83%]). Venous flow-related enhancement 
was present in 10 cases (91%). A sole false-negative case on MRA, as compared 
with conventional angiography, resulted from nonvisualization of the slow venous 
flow (8%). No false-positive fistula was found at the other intracranial sites 
in all cases. Overall, MRA assessment for DAVF was adequate for both fistula and 
venous flow-related enhancement in 10 cases (91%) and inadequate in a remaining 
case because of the fistular location out of field.
CONCLUSION: MR imaging demonstration of leptomeningeal or medullary vascular 
dilation and enhancements may be associated with features that are considered 
predictors of a poor outcome and indicates a need for urgent therapy in 
intracranial dural AVF patients. MRA is a complementary tool for the 
identification of dural AVF with venous flow-related enhancement.