Time-Resolved Magnetic Resonance Angiography for Follow-Up of Treated Dural and Epidural Spinal Arteriovenous Fistula

Abstract

Background Spinal arteriovenous fistulas (AVFs) are uncommon vascular malformations of spinal dural and epidural vessels. Actually digital subtraction angiography (DSA) is the gold standard for diagnosis and follow-up. The aim of this study is to demonstrate the validity of the multiphasic magnetic resonance angiography (MRA) to identify recurrent/residual AVFs or their correct surgical and/or endovascular closure. Methods A retrospective cases series with perimedullary venous plexus congestion due to spinal dural or epidural AVF was performed at our center from April 2014 to September 2019. After 1 month from treatment, the patients were subjected to time-resolved MRA and DSA to demonstrate recurrence or correct closure of AVFs. Results We collected a series of 26 matched time-resolved MRA and DSA in 20 patients who underwent an endovascular and/or surgical procedure. In our series, we reported five cases of recurrence. Time-resolved MRA detected six cases of recurrence, with 100% sensitivity and 95% specificity (p < 0.001). We used DSA as the standard reference. Conclusion Time-resolved MRA is a valid tool in posttreatment follow-up to detect recurrent or residual AVFs. It has high sensitivity and specificity and may replace DSA.

Spinal dural and epidural arteriovenous fistula: Recurrence rate after surgical and endovascular treatment

“…Patients with DAVFs underwent a total of 29 procedures ( Table 2 ) of which 16 surgical interventions and 13 endovascular treatments. At follow-up radiological examinations (MRA and/or spinal angiography) ( 8 ) all 16 patients who underwent surgery did not show disease recurrence, while in the endovascular treatment group six of them showed a recurrence (46%). These results reached a statistical significance ( p < 0.004).…”

“…The identifications of DAVF o EAVF are common with Magnetic Resonance Angiography (MRA) that usually shows Flow voids surrounding the spinal cord corresponding to congested coronal venous plexus with good sensitivity ( 8 ). In EAVFs the arterovenous shunt is in the epidural space and only secondarily the intradural venous plexus can be involved, while in DAVFs the arteriovenous shunt is located within the dural sheath of the nerve root and drains directly into an intradural vein without filling of the epidural space ( 9 ).…”

To Draw a Detailed Map for Maxillofacial Fast-Flow Vascular Diseases With the Combination of Color Doppler Ultrasound and Three-Dimensional Computed Tomography Angiography

“…Color Doppler ultrasound can also accurately locate the orificium fistulae, display its modality, and show the changes in hemodynamics in real time. 12,13 Although DSA is the gold standard for the diagnosis of AVFs, 14 the orificium fistulaes in AVFs of the superficial arteries (such as the superficial temporal arteries) can be easily found and marked on the body surface by the ultrasound without any radiation. This map can lead to a better surgery plan and less damage to the tissues (in all cases).…”

A very rare complication after knee arthroplasty: a case description of postoperative acute paraplegia

“…MRI is an important tool for diagnosing SDAVF, as it can detect abnormal vascular flow-void images in the spinal canal and initially determine the location of the malformed vessels, their direction, and the degree of spinal cord oedema ( 17 ). On MRI, the fluid that causes spinal edema thickens to a slightly low signal on the T1 images and a high signal in the medulla on the T2 images, and enhanced sequences reveal twisted, enlarged, and malformed draining veins ( 18 ). Spinal angiography can identify the location of the fistula, the blood supply artery, and the drainage vein and is considered by most investigators to be the current gold standard for the diagnosis of SDAVF.…”