Gadolinium-DTPA Enhanced MR Imaging of Spinal Dural Arteriovenous Fistulas

Terwey, B; Becker, H.; Thron, A.; Vahldiek, G.

doi:10.1097/00004728-198901000-00006

Cited by 89 publications

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“…On MRI, SDAVFs are characterized by an increased T2 signal within the spinal cord and conus medullaris which is thought to be related to venous hypertension and resultant cord swelling 3 5. This can be associated with enhancement following contrast administration, reflecting breakdown of the blood/spinal cord barrier 14 15. The MRI appearance can mimic various other etiologies including inflammatory or infectious myelitis and cord edema from spinal canal stenosis.…”

Section: Discussionmentioning

confidence: 99%

Contrast-enhanced time-resolved MRA for pre-angiographic evaluation of suspected spinal dural arterial venous fistulas

Saindane

Boddu

Tong

et al. 2014

J NeuroIntervent Surg

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Section: Discussionmentioning

confidence: 99%

Contrast-enhanced time-resolved MRA for pre-angiographic evaluation of suspected spinal dural arterial venous fistulas

Saindane

Boddu

Tong

et al. 2014

J NeuroIntervent Surg

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“…Findings suggestive of spinal dural AVF at conventional spin-echo MR imaging have been well documented (3,(11)(12)(13)(14). These findings include mild enlargement of the cord, obscuration of cord margins, gadolinium enhancement, and central hyperintensity on T2-weighted images within the lower spinal cord and conus, as well as multiple vascular flow voids posterior to the spinal cord.…”

Section: Discussionmentioning

confidence: 99%

Spinal Dural Arteriovenous Fistula Localization with a Technique of First-Pass Gadolinium-enhanced MR Angiography: Initial Experience

Farb¹,

Kim²,

Willinsky³

et al. 2002

Radiology

115

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Nine patients with initial magnetic resonance (MR) imaging and clinical findings suggestive of spinal dural arteriovenous fistula (AVF) underwent spinal MR angiography with an autotriggered elliptic centric ordered three-dimensional gadolinium-enhanced technique (hereafter, this MR angiographic technique) before conventional intraarterial angiography. In all nine patients, findings with this MR angiographic technique correctly and precisely localized the spinal dural AVF. Observer error resulted in one case in which the site of the fistula was not prospectively reported but was easily identified retrospectively on the spinal MR angiogram.

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“…Following contrast administration, diffuse enhancement may be seen within the cord as a sign of chronic venous congestion with a breakdown of the bloodϪspinal cord barrier (Fig 4). 49,50 SDAVFs may occur anywhere from the level of the foramen magnum to the sacrum and localization of these lesions may be difficult and challenging, especially in cases in which cord edema occurs distant from the AV shunt location. 51 Thus, the noninvasive evaluation of the shunt location is extremely helpful to guide the invasive conventional angiography.…”

Section: Clinical Featuresmentioning

confidence: 99%

Spinal Dural Arteriovenous Fistulas

Krings¹,

Geibprasert²

2009

AJNR Am J Neuroradiol

374

376

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SUMMARY:Spinal dural arteriovenous (AV) fistulas are the most commonly encountered vascular malformation of the spinal cord and a treatable cause for progressive para-or tetraplegia. They most commonly affect elderly men and are classically found in the thoracolumbar region. The AV shunt is located inside the dura mater close to the spinal nerve root where the arterial blood from a radiculomeningeal artery enters a radicular vein. The increase in spinal venous pressure leads to decreased drainage of normal spinal veins, venous congestion, and the clinical findings of progressive myelopathy. On MR imaging, the combination of cord edema, perimedullary dilated vessels, and cord enhancement is characteristic. Therapy has to be aimed at occluding the shunting zone, either by superselective embolization with a liquid embolic agent or by a neurosurgical approach. Following occlusion of the fistula, the progression of the disease can be stopped and improvement of symptoms is typically observed. Despite being the most commonly encountered spinal vascular malformation, spinal dural arteriovenous fistulas (SDAVFs) are rare and still underdiagnosed entities, which, if not treated properly, can lead to considerable morbidity with progressive spinal cord symptoms. Because presenting clinical symptoms are unspecific, the neuroradiologist is often the first clinician to raise the possibility of this diagnosis, which initially rests mainly on MR imaging. For a thorough understanding of the disease and for planning the therapeutic strategy, however, selective spinal digital subtraction angiography (DSA) still is necessary. The aim of the following article is to review the epidemiology, etiology, clinical and imaging features, and therapeutic approaches of this type of spinal vascular malformation. Because an understanding of spinal vascular malformations both from an etiologic and pathophysiologic standpoint is based on the spinal vascular anatomy, we will start by briefly describing the salient features of the spine and spinal cord arterial supply and venous drainage followed by a classification of spinal vascular malformations in general and a classification of dural arteriovenous (AV) shunts in particular. Embryology and Anatomy of the Spinal VasculatureDevelopment of the neural plate starts during the third gestational week and is derived from the embryologic ectoderm. This process is induced by the underlying notochord and adjacent mesoderm, which regulate the development of the surrounding structures, including the nerves, blood vessels, and somites.1 In this stage, the angioblasts initially form small cell clusters (blood islands) within the embryonic and extraembryonic mesoderm.2 Formation of the neural tube begins early in the fourth week (days 22-23) with closure of the rostral and caudal neuropore during days 25-27, which coincides with the establishment of the intrinsic blood vascular circulation within the spinal cord.3 Two longitudinal collector systems form in the subarachnoid space at the dorsal and ventral surfac...

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Gadolinium-DTPA Enhanced MR Imaging of Spinal Dural Arteriovenous Fistulas

Cited by 89 publications

References 0 publications

Contrast-enhanced time-resolved MRA for pre-angiographic evaluation of suspected spinal dural arterial venous fistulas

Contrast-enhanced time-resolved MRA for pre-angiographic evaluation of suspected spinal dural arterial venous fistulas

Spinal Dural Arteriovenous Fistula Localization with a Technique of First-Pass Gadolinium-enhanced MR Angiography: Initial Experience

Spinal Dural Arteriovenous Fistulas

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