First-Pass Contrast-Enhanced MRA for Pretherapeutic Diagnosis of Spinal Epidural Arteriovenous Fistulas with Intradural Venous Reflux

Spinal epidural AVFs are rare spinal vascular malformations. When there is associated intradural venous reflux, they may mimic the more common spinal dural AVFs. Correct diagnosis and localization before conventional angiography is beneficial to facilitate treatment. We hypothesize that first-pass c...

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Bibliographic Details
Published in:American journal of neuroradiology : AJNR 2017-01, Vol.38 (1), p.195-199
Main Authors: Mathur, S, Symons, S P, Huynh, T J, Muthusami, P, Montanera, W, Bharatha, A
Format: Article
Language:English
Subjects:
Aged
Angiography
Angiography, Digital Subtraction - methods
Central Nervous System Vascular Malformations - diagnostic imaging
Central Nervous System Vascular Malformations - pathology
Diagnosis
Diagnostic systems
Epidural Space - diagnostic imaging
Epidural Space - pathology
Female
Humans
Interventional
Lesions
Localization
Magnetic Resonance Angiography - methods
Magnetic resonance imaging
Male
Middle Aged
Refluxing
Spinal Cord - diagnostic imaging
Spinal Cord - pathology
Spine
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Summary:Spinal epidural AVFs are rare spinal vascular malformations. When there is associated intradural venous reflux, they may mimic the more common spinal dural AVFs. Correct diagnosis and localization before conventional angiography is beneficial to facilitate treatment. We hypothesize that first-pass contrast-enhanced MRA can diagnose and localize spinal epidural AVFs with intradural venous reflux and distinguish them from other spinal AVFs. Forty-two consecutive patients with a clinical and/or radiologic suspicion of spinal AVF underwent MR imaging, first-pass contrast-enhanced MRA, and DSA at a single institute (2000-2015). MR imaging/MRA and DSA studies were reviewed by 2 independent blinded observers. DSA was used as the reference standard. On MRA, all 7 spinal epidural AVFs with intradural venous reflux were correctly diagnosed and localized with no interobserver disagreement. The key diagnostic feature was arterialized filling of an epidural venous pouch with a refluxing radicular vein arising from the arterialized epidural venous system. First-pass contrast-enhanced MRA is a reliable and useful technique for the initial diagnosis and localization of spinal epidural AVFs with intradural venous reflux and can distinguish these lesions from other spinal AVFs.
ISSN:0195-6108
1936-959X
DOI:10.3174/ajnr.A5008