OBJECTIVES: The purpose of this study was to determine the accuracy and utility of contrast-enhanced MR angiography (CE-MRA) in spinal dural arteriovenous fistulas (SDAVF). METHODS: A retrospective analysis from 1999-2012 identified 70 patients clinically suspected of harboring a SDAVF. Each patient underwent consecutive conventional MR-imaging, CE-MRA, and digital subtraction angiography (DSA). The presence or absence of serpentine flow voids, T2-weighted hyperintensity, and cord enhancement were evaluated, as well as location of the fistula as predicted by CE-MRA. DSA was used as the reference standard. RESULTS: Of the 70 cases, 53 were determined to be a SDAVF, 10 cases were shown to be other forms of vascular malformation, and 7 were DSA-negative. On MRI, all reported cases of SDAVF showed serpentine flow voids (100 %). T2-weighted hyperintensity was seen in 48 of 50 cases (96 %), extending to the conus in 41 of 48 cases (85 %). Cord enhancement was seen in 38 of 41 cases (93 %). CE-MRA correctly localized the SDAVF in 43 of the 53 cases (81 %). CONCLUSIONS: CE-MRA is a useful non-invasive examination for the detection and localization of SDAVF. CE-MRA facilitates but does not replace DSA as confirmation of location, fistula type, and arterial detail, which are required before treatment. KEY POINTS: • CE-MRA correctly localized the site of the SDAVF in over 80 % of cases. • CE-MRA facilitates diagnostic DSA and expedites the diagnostic process. • CE-MRA does not replace diagnostic DSA in SDAVF cases as confirmative test. • CE-MRA provides better understanding of missed or mislocalized SDAVF cases.
OBJECTIVES: The purpose of this study was to determine the accuracy and utility of contrast-enhanced MR angiography (CE-MRA) in spinal dural arteriovenous fistulas (SDAVF). METHODS: A retrospective analysis from 1999-2012 identified 70 patients clinically suspected of harboring a SDAVF. Each patient underwent consecutive conventional MR-imaging, CE-MRA, and digital subtraction angiography (DSA). The presence or absence of serpentine flow voids, T2-weighted hyperintensity, and cord enhancement were evaluated, as well as location of the fistula as predicted by CE-MRA. DSA was used as the reference standard. RESULTS: Of the 70 cases, 53 were determined to be a SDAVF, 10 cases were shown to be other forms of vascular malformation, and 7 were DSA-negative. On MRI, all reported cases of SDAVF showed serpentine flow voids (100 %). T2-weighted hyperintensity was seen in 48 of 50 cases (96 %), extending to the conus in 41 of 48 cases (85 %). Cord enhancement was seen in 38 of 41 cases (93 %). CE-MRA correctly localized the SDAVF in 43 of the 53 cases (81 %). CONCLUSIONS: CE-MRA is a useful non-invasive examination for the detection and localization of SDAVF. CE-MRA facilitates but does not replace DSA as confirmation of location, fistula type, and arterial detail, which are required before treatment. KEY POINTS: • CE-MRA correctly localized the site of the SDAVF in over 80 % of cases. • CE-MRA facilitates diagnostic DSA and expedites the diagnostic process. • CE-MRA does not replace diagnostic DSA in SDAVF cases as confirmative test. • CE-MRA provides better understanding of missed or mislocalized SDAVF cases.
Authors: Richard I Farb; Jae K Kim; Robert A Willinsky; Walter J Montanera; Karel terBrugge; J Andrew Derbyshire; J Marc C van Dijk; Graham A Wright Journal: Radiology Date: 2002-03 Impact factor: 11.105
Authors: Jared Narvid; Steven W Hetts; Donald Larsen; John Neuhaus; Tejinder P Singh; Hugh McSwain; Michael T Lawton; Christopher F Dowd; Randall T Higashida; Van V Halbach Journal: Neurosurgery Date: 2008-01 Impact factor: 4.654