Analysis of 30 Spinal Angiograms Falsely Reported as Normal in 18 Patients with Subsequently Documented Spinal Vascular Malformations

Barreras, Paula; Heck, Donald; Greenberg, Benjamin; Wolinsky, Jean Paul; Pardo, Carlos A.; Gailloud, Philippe

doi:10.3174/ajnr.a5275

Cited by 31 publications

(23 citation statements)

References 8 publications

(9 reference statements)

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“…For instance, for the lateral sacral arteries, the catheterization of the internal iliac artery is not sufficient because proximal injection may lead to poor opacification of the lateral sacral arteries (Fig 1). In the article of Barreras et al, 1 most of the missed fistulas (52.9%) were at or below the L4 level, which confirms the need for a complete spinal DSA, including the lower spinal supplies.…”

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confidence: 77%

“…W e read with great interest the article recently published in the American Journal of Neuroradiology by Barreras et al 1 entitled, "Analysis of 30 Spinal Angiograms Falsely Reported as Normal in 18 Patients with Subsequently Documented Spinal Vascular Malformations." This very valuable article for the interventional neuroradiology and neurosurgical communities presents the causes of false-negative digital subtraction angiography findings for the depiction of spinal dural arteriovenous fistulas (SDAVFs).…”

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confidence: 99%

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Spinal Angiogram: A Treacherous Criterion Standard…

Clarençon

Shotar

Boch

et al. 2018

AJNR Am J Neuroradiol

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confidence: 77%

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confidence: 99%

Spinal Angiogram: A Treacherous Criterion Standard…

Clarençon

Shotar

Boch

et al. 2018

AJNR Am J Neuroradiol

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“…It occurs when the arteries supplying the nerve roots or dura mater communicate with the spinal drainage vein when passing through the dura mater at the intervertebral foramen. Because the incidence of SDAVF is extremely low and the clinical manifestations are not typical [5], early diagnosis is not easy, and the misdiagnosis rate is high [6,7]. If diagnosis and treatment are delayed, spinal venous pressure continues to increase and can cause spinal cord ischemia and edema and even irreversible injuries, such as necrosis and demyelination.…”

Section: Discussionmentioning

confidence: 99%

Misdiagnosis of Spinal Dural Arteriovenous Fistula: An Analysis of 12 Cases

Yang

Cao

et al. 2020

Preprint

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Background: Spinal dural arteriovenous fistula (SDAVF) is a rare spinal vascular disease. The clinical misdiagnosis rate is very high. The highest misdiagnosis rate is reported in orthopedics. The specific reason for misdiagnosis remains unclear. Objective: To investigate the clinical and imaging manifestations of SDAVF, analyze the causes of misdiagnosis, propose countermeasures, and improve the orthopedists and other specialists’ understanding of this disease. Methods: The clinical data, diagnosis and treatment of 12 patients who had SDAVF that was misdiagnosed as a different disease were retrospectively analyzed, and the modified Aminoff-Logue Disability Scale (ALS) scores before and during follow-up were compared. Results: From 2014 to February 2019, 15 patients were diagnosed with SDAVF at our institution. Twelve (80%) were misdiagnosed; of these, 6 (50%) were misdiagnosed more than twice, and 6 patients (50%) were misdiagnosed at least once. The initial diagnoses included lumbar spinal stenosis and lumbar disc herniation (LDH) in 6 patients, cervical spinal stenosis in one patient, benign prostatic hyperplasia (BPH) in one patient, myelitis in 2 patients, and syringomyelia in one patient. After the initial diagnosis, one patient was misdiagnosed with LDH, one was misdiagnosed with subacute combined degeneration of the spinal cord, and 4 were misdiagnosed with myelitis. The clinical manifestations mainly included weakness and numbness of the lower limbs, urinary symptoms, and numbness of the perineal area. In the 12 misdiagnosed patients, magnetic resonance imaging(MRI) showed signs of spinal cord edema and typical or atypical flow-void patterns. One patient had undergone extended cervical decompression and lumbar decompression. All patients eventually underwent microsurgical treatment. The average follow-up duration was 0.9 years. The modified ALS scores showed significant improvement in gait, bladder function and bowel movement, and the differences before and during follow-up were statistically significant (P<0.05). Conclusion: When patients, especially those with bladder and bowel dysfunction, have symptoms such as weakness of the lower limbs and/or numbness, a diagnosis of SDAVF should be considered. Furthermore, if MRI shows signs of spinal cord edema and typical or atypical flow-void patterns, the diagnosis of SDAVF should be strongly considered, and further angiography is needed to confirm the diagnosis.

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“…It is important to note that recent studies have demonstrated operator-dependent and avoidable missed diagnoses in patients. These factors included: documented but not identified lesions, lack of documenting regions of interest, inadequate injection leading to poor visualization, and involvement of vessels outside of the spine [16].…”

Section: Spinal Digital Subtraction Angiographymentioning

confidence: 99%