© American Society of Neuroimaging. The diagnosis of dural carotid-cavernous fistula is often elusive. The 2 patients described experienced the insidious onset of ocular signs and symptoms. Evaluation over several months including computed tomography and magnetic resonance imaging revealed only nonspecific abnormalities. In both patients, magnetic resonance angiography showed features characteristic of carotid-cavernous shunting, confirmed by cerebral arteriography. Magnetic resonance angiography is an important tool for the evaluation of patients with suspected dural carotidcavernous fistulas.