{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T15:37:18Z","timestamp":1767109038328,"version":"3.37.3"},"reference-count":20,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2021,6,8]],"date-time":"2021-06-08T00:00:00Z","timestamp":1623110400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,6,8]],"date-time":"2021-06-08T00:00:00Z","timestamp":1623110400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e4tsklinikum Schleswig-Holstein - Campus L\u00fcbeck"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Clin Neuroradiol"],"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Purpose<\/jats:title>\n                <jats:p>Together with the foramen ovale, the middle meningeal artery (MMA) looks like a\u00a0high heel shoe print on axial time-of-flight magnetic resonance angiography (TOF-MRA) images, with the MMA resembling the heel. Cranial dural arteriovenous fistulas (DAVF) are often fed by the MMA, which can lead to an increase of signal intensity and diameter of this vessel, resulting in a\u00a0more \u201cshiny\u201d and \u201cthick\u201d high heel print appearance than on the contralateral side. We describe this finding as a\u00a0novel radiologic sign and provide cut-off values for the ratios of MMA signal intensities and diameters for predicting the presence of a\u00a0DAVF.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>A\u00a0total of 84\u00a0TOF-MRA examinations of 44\u00a0patients with DAVFs (40\u00a0with unilateral MMA feeders, 4\u00a0with bilateral feeders) and of 40\u00a0patients without DAVFs were included. Diameters and signal intensities of both MMAs were measured by two raters and evaluated using receiver operating characteristic analysis.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The diameters of feeding and non-feeding MMAs differed significantly, as did the ratios of signal intensities and of diameters of DAVF and control patients (<jats:italic>P<\/jats:italic>\u202f&lt;\u20090.0001). Cut-off values were 1.25 for average signal intensity ratio (shiny high heel sign) and 1.21 for diameter ratio (thick high heel sign). The combination of the \u201cshiny\u201d and the \u201cthick\u201d high heel sign resulted in the highest sensitivity (92.5%) and positive predictive value (95%).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>The described sign seems promising for the detection of DAVFs with noncontrast-enhanced MRI. The TOF-MRA source images should be reviewed with special attention to the MMA.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00062-021-01036-y","type":"journal-article","created":{"date-parts":[[2021,6,8]],"date-time":"2021-06-08T16:03:17Z","timestamp":1623168197000},"page":"465-470","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["The \u201cShiny and Thick High Heel Sign\u201d"],"prefix":"10.1007","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5130-9145","authenticated-orcid":false,"given":"Hannes","family":"Schacht","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0504-6465","authenticated-orcid":false,"given":"Inke Regina","family":"K\u00f6nig","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6594-5334","authenticated-orcid":false,"given":"Johannes","family":"Hensler","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3245-7692","authenticated-orcid":false,"given":"Peter","family":"Schramm","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2587-3129","authenticated-orcid":false,"given":"Jan","family":"K\u00fcchler","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2925-8537","authenticated-orcid":false,"given":"Claudia","family":"Ditz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5651-3900","authenticated-orcid":false,"given":"Alexander","family":"Neumann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,6,8]]},"reference":[{"key":"1036_CR1","first-page":"877","volume":"28","author":"S Meckel","year":"2007","unstructured":"Meckel S, Maier M, Ruiz DS, Yilmaz H, Scheffler K, Radue EW, Wetzel SG. 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I.\u00a0R.\u00a0K\u00f6nig, J.\u00a0Hensler, P.\u00a0Schramm, J.\u00a0K\u00fcchler, C.\u00a0Ditz and A.\u00a0Neumann declare that they have no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case. Approval of the institutional review board was obtained (registry number: 19-336A).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical standards"}}]}}