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European Radiology
Published in: European Radiology 11/2014

01-11-2014 | Neuro

The accuracy and utility of contrast-enhanced MR angiography for localization of spinal dural arteriovenous fistulas: the Toronto experience

Authors: Arjen Lindenholz, Karel G. TerBrugge, J. Marc C. van Dijk, Richard I. Farb

Published in: European Radiology | Issue 11/2014

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Abstract

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.
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Metadata
Title
The accuracy and utility of contrast-enhanced MR angiography for localization of spinal dural arteriovenous fistulas: the Toronto experience
Authors
Arjen Lindenholz
Karel G. TerBrugge
J. Marc C. van Dijk
Richard I. Farb
Publication date
01-11-2014
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 11/2014
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-014-3307-6

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