Clinical and Radiologic Characteristics of Deep Lumbosacral Dural Arteriovenous Fistulas

Twenty patients with deep lumbosacral spinal dural arteriovenous fistulas were included in this series. Cord T2 hyperintensity and contrast enhancement were present in most cases. The filum vein and/or lumbar veins were dilated in 95% of patients. Time-resolved contrast-enhanced dynamic MRA indicate...

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Published in:American journal of neuroradiology : AJNR 2018-02, Vol.39 (2), p.392-398
Main Authors: Jablawi, F, Nikoubashman, O, Schubert, G A, Dafotakis, M, Hans, F-J, Mull, M
Format: Article
Language:English
Subjects:
Angiography
Arteries
Enlargement
Fellows' Journal Club
Fistula
Fistulae
Medical imaging
Patients
Sensitivity
Sphincter
Spine
Veins
Veins & arteries
Vertebrae
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Summary:Twenty patients with deep lumbosacral spinal dural arteriovenous fistulas were included in this series. Cord T2 hyperintensity and contrast enhancement were present in most cases. The filum vein and/or lumbar veins were dilated in 95% of patients. Time-resolved contrast-enhanced dynamic MRA indicated a spinal DAVF at or below the L5 vertebral level in 7/8 (88%) patients who received time-resolved contrast-enhanced dynamic MRA before DSA. A bilateral arterial supply of the fistula was detected via DSA in 5 (25%) patients. The authors conclude that time-resolved contrast-enhanced dynamic MRA facilitates the detection of the drainage vein and helps to localize deep lumbosacral-located fistulas with a high sensitivity before DSA. Definite detection remains challenging and requires conventional spinal angiography.BACKGROUND AND PURPOSE:Spinal dural arteriovenous fistulas located in the deep lumbosacral region are rare and the most difficult to diagnose among spinal dural arteriovenous fistulas located elsewhere in the spinal dura. Specific clinical and radiologic features of these fistulas are still inadequately reported and are the subject of this study.MATERIALS AND METHODS:We retrospectively evaluated all data of patients with spinal dural arteriovenous fistulas treated and/or diagnosed in our institution between 1990 and 2017. Twenty patients with deep lumbosacral spinal dural arteriovenous fistulas were included in this study.RESULTS:The most common neurologic findings at the time of admission were paraparesis (85%), sphincter dysfunction (70%), and sensory disturbances (20%). Medullary T2 hyperintensity and contrast enhancement were present in most cases. The filum vein and/or lumbar veins were dilated in 19/20 (95%) patients. Time-resolved contrast-enhanced dynamic MRA indicated a spinal dural arteriovenous fistula at or below the L5 vertebral level in 7/8 (88%) patients who received time-resolved contrast-enhanced dynamic MRA before DSA. A bilateral arterial supply of the fistula was detected via DSA in 5 (25%) patients.CONCLUSIONS:Clinical symptoms caused by deep lumbosacral spinal dural arteriovenous fistulas are comparable with those of spinal dural arteriovenous fistulas at other locations. Medullary congestion in association with an enlargement of the filum vein or other lumbar radicular veins is a characteristic finding in these patients. Spinal time-resolved contrast-enhanced dynamic MRA facilitates the detection of the drainage vein and helps to
ISSN:0195-6108
1936-959X
DOI:10.3174/ajnr.a5497