Skip to main content
Log in

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

  • Neuro
  • Published:
European Radiology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Abbreviations

SDAVF:

Spinal dural arteriovenous fistula

CE-MRA:

Contrast-enhanced magnetic resonance angiography

DSA:

Digital subtraction angiography

FOV:

Field of view

References

  1. Narvid J, Hetts SW, Larsen D et al (2008) Spinal dural arteriovenous fistulae: clinical features and long-term results. Neurosurgery 62:159–166, discussion 166–157

    Article  PubMed  Google Scholar 

  2. Van Dijk JM, TerBrugge KG, Willinsky RA et al (2002) Multidisciplinary management of spinal dural arteriovenous fistulas: clinical presentation and long-term follow-up in 49 patients. Stroke 33:1578–1583

    Article  PubMed  Google Scholar 

  3. Krings T, Geibprasert S (2009) Spinal dural arteriovenous fistulas. AJNR Am J Neuroradiol 30:639–648

    Article  PubMed  CAS  Google Scholar 

  4. McCutcheon IE, Doppman JL, Oldfield EH (1996) Microvascular anatomy of dural arteriovenous abnormalities of the spine: a microangiographic study. J Neurosurg 84:215–220

    Article  PubMed  CAS  Google Scholar 

  5. Aminoff MJ, Barnard RO, Logue V (1974) The pathophysiology of spinal vascular malformations. J Neurol Sci 23:255–263

    Article  PubMed  CAS  Google Scholar 

  6. Toossi S, Josephson SA, Hetts SW et al (2012) Utility of MRI in spinal arteriovenous fistula. Neurology 79:25–30

    Article  PubMed  Google Scholar 

  7. Muralidharan R, Saladino A, Lanzino G et al (2011) The clinical and radiological presentation of spinal dural arteriovenous fistula. Spine (Phila Pa 1976) 36:E1641–E1647

    Article  Google Scholar 

  8. Jackson JPS (2003) Imaging of spinal cord vascular malformations. Oper Tech Neurosurg 6:125–140

    Article  Google Scholar 

  9. Gilbertson JR, Miller GM, Goldman MS et al (1995) Spinal dural arteriovenous fistulas: MR and myelographic findings. AJNR Am J Neuroradiol 16:2049–2057

    PubMed  CAS  Google Scholar 

  10. Willinsky RA, terBrugge K, Montanera W et al (1995) Posttreatment MR findings in spinal dural arteriovenous malformations. AJNR Am J Neuroradiol 16:2063–2071

    PubMed  CAS  Google Scholar 

  11. Bowen BC, Fraser K, Kochan JP et al (1995) Spinal dural arteriovenous fistulas: evaluation with MR angiography. AJNR Am J Neuroradiol 16:2029–2043

    PubMed  CAS  Google Scholar 

  12. Binkert CA, Kollias SS, Valavanis A (1999) Spinal cord vascular disease: characterization with fast three-dimensional contrast-enhanced MR angiography. AJNR Am J Neuroradiol 20:1785–1793

    PubMed  CAS  Google Scholar 

  13. Farb RI, Kim JK, Willinsky RA et al (2002) Spinal dural arteriovenous fistula localization with a technique of first-pass gadolinium-enhanced MR angiography: initial experience. Radiology 222:843–850

    Article  PubMed  Google Scholar 

  14. Saraf-Lavi E, Bowen BC, Quencer RM et al (2002) Detection of spinal dural arteriovenous fistulae with MR imaging and contrast-enhanced MR angiography: sensitivity, specificity, and prediction of vertebral level. AJNR Am J Neuroradiol 23:858–867

    PubMed  Google Scholar 

  15. Luetmer PH, Lane JI, Gilbertson JR et al (2005) Preangiographic evaluation of spinal dural arteriovenous fistulas with elliptic centric contrast-enhanced MR Angiography and effect on radiation dose and volume of iodinated contrast material. AJNR Am J Neuroradiol 26:711–718

    PubMed  Google Scholar 

  16. Krings T, Lasjaunias PL, Hans FJ et al (2007) Imaging in spinal vascular disease. Neuroimaging Clin N Am 17:57–72

    Article  PubMed  Google Scholar 

  17. Mull M, Nijenhuis RJ, Backes WH et al (2007) Value and limitations of contrast-enhanced MR angiography in spinal arteriovenous malformations and dural arteriovenous fistulas. AJNR Am J Neuroradiol 28:1249–1258

    Article  PubMed  CAS  Google Scholar 

  18. Yamaguchi S, Nagayama T, Eguchi K et al (2010) Accuracy and pitfalls of multidetector-row computed tomography in detecting spinal dural arteriovenous fistulas. J Neurosurg Spine 12:243–248

    Article  PubMed  Google Scholar 

  19. Zampakis P, Santosh C, Taylor W et al (2006) The role of non-invasive computed tomography in patients with suspected dural fistulas with spinal drainage. Neurosurgery 58:686–694, discussion 686–694

    Article  PubMed  Google Scholar 

  20. Si-jia G, Meng-wei Z, Xi-ping L et al (2009) The clinical application studies of CT spinal angiography with 64-detector row spiral CT in diagnosing spinal vascular malformations. Eur J Radiol 71:22–28

    Article  PubMed  Google Scholar 

  21. Backes WH, Nijenhuis RJ (2008) Advances in spinal cord MR angiography. AJNR Am J Neuroradiol 29:619–631

    Article  PubMed  CAS  Google Scholar 

  22. Willinsky R, Lasjaunias P, terBrugge K et al (1990) Angiography in the investigation of spinal dural arteriovenous fistula A protocol with application of the venous phase. Neuroradiology 32:114–116

    Article  PubMed  CAS  Google Scholar 

  23. Pattany PM, Saraf-Lavi E, Bowen BC (2003) MR angiography of the spine and spinal cord. Top Magn Reson Imaging 14:444–460

    Article  PubMed  Google Scholar 

  24. Provenzale JM, Tien RD, Felsberg GJ et al (1994) Spinal dural arteriovenous fistula: demonstration using phase contrast MRA. J Comput Assist Tomogr 18:811–814

    Article  PubMed  CAS  Google Scholar 

  25. Soher BJ, Dale BM, Merkle EM (2007) A review of MR physics: 3T versus 1.5T. Magn Reson Imaging Clin N Am 15:277–290, v

    Article  PubMed  Google Scholar 

  26. Boeckh-Behrens T, Bitterling H, Schichor C et al (2010) Improved localization of spinal AV fistulas using contrast-enhanced MR angiography at 3T. Röfo 182:53–57

    PubMed  CAS  Google Scholar 

  27. Vargas MI, Nguyen D, Viallon M et al (2010) Dynamic MR angiography (MRA) of spinal vascular diseases at 3T. Eur Radiol 20:2491–2495

    Article  PubMed  Google Scholar 

  28. Riccioli LA, Marliani AF, Ghedin P et al (2007) CE-MR Angiography at 3.0T magnetic field in the study of spinal dural arteriovenous fistula. Preliminary Results. Interv Neuroradiol 13:13–18

    PubMed  Google Scholar 

  29. Ali S, Cashen TA, Carroll TJ et al (2007) Time-resolved spinal MR angiography: initial clinical experience in the evaluation of spinal arteriovenous shunts. AJNR Am J Neuroradiol 28:1806–1810

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

The authors gratefully acknowledge A. Kostynskyy (research coordinator at Toronto Western Hospital) for his assistance with this project. The scientific guarantor of this publication is R.I. Farb. The authors of this manuscript declare no relationship with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board.

Some study subjects or cohorts have been (likely) previously reported in Farb RI, Kim J, Willinsky RA, et al. Spinal Dural Arteriovenous Fistula Localization with a Technique of First-Pass Gadolinium-enhanced MR Angiography: Initial Experience. Radiology 2002;222:843–850.

Methodology: retrospective diagnostic or prognostic study/observational, performed at one institution.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Arjen Lindenholz.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lindenholz, A., TerBrugge, K.G., van Dijk, J.M.C. et al. The accuracy and utility of contrast-enhanced MR angiography for localization of spinal dural arteriovenous fistulas: the Toronto experience. Eur Radiol 24, 2885–2894 (2014). https://doi.org/10.1007/s00330-014-3307-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-014-3307-6

Keywords

Navigation