Localization of spinal dural arteriovenous fistulas from the spatial relationships of perimedullary vessels on standard MRI

Ali Moosavi Departments of Radiology and

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Paul Kalapos Departments of Radiology and

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Ephraim W. Church Neurosurgery, Penn State Health Hershey Medical Center, Penn State University, Hershey, Pennsylvania

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Kevin M. Cockroft Neurosurgery, Penn State Health Hershey Medical Center, Penn State University, Hershey, Pennsylvania

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Krishnamoorthy Thamburaj Departments of Radiology and

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OBJECTIVE

The goal in this study was to explore the spatial relationship of perimedullary vessels visualized on MRI to localize the side and the site of spinal dural arteriovenous fistula (SDAVF).

METHODS

A retrospective analysis of 30 consecutive patients diagnosed with SDAVF on MRI was undertaken. Two experienced reviewers blinded to all reports and angiographic images analyzed T2-weighted as well as postcontrast T1-weighted sequences. A focal prominent zone of perimedullary vessels with lateralization to one side in the thecal space was evaluated to locate the side and the site of the fistula. Spinal digital subtraction angiography served as the gold standard technique.

RESULTS

Good interrater agreement (κ = 0.77) was shown for the diagnosis of SDAVF with perimedullary vessels on T2-weighted MRI. Flow voids on T2-weighted MRI demonstrated a sensitivity of 1.0 (95% CI 1.0–1.0) and an accuracy of 0.87 (95% CI 0.79–0.95) to identify the presence of fistula. The flow voids on T2-weighted MRI also demonstrated 0.88 (95% CI 0.71–1.03) sensitivity and 0.81 (95% CI 0.70–0.92) accuracy to identify the side of SDAVF. Furthermore, flow voids on T2-weighted MRI showed 0.87 (95% CI 0.71–1.03) sensitivity and 0.87 (95% CI 0.79–0.95) accuracy to identify the site of SDAVF within 3 vertebral levels above or below the actual site. Area under the receiver operating characteristic curve demonstrated significant results (0.87 [95% CI 0.73–1.0]; p < 0.001) for flow voids on T2-weighted MRI to identify the site of shunts within 3 vertebral levels in the cranial or caudal direction.

CONCLUSIONS

Spatial distribution of perimedullary vessels observed on standard MRI show promise to locate the side and the site of fistula in patients with SDAVF.

ABBREVIATIONS

AVM = arteriovenous malformation; DSA = digital subtraction angiography; ROC = receiver operating characteristic; SDAVF = spinal dural arteriovenous fistula; TSE = turbo spin echo.

Supplementary Materials

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Images from Özer and Demirtaş (pp 351–358).
  • 1

    Krings T, Geibprasert S. Spinal dural arteriovenous fistulas. AJNR Am J Neuroradiol. 2009;30(4):639-648.

  • 2

    Toossi S, Josephson SA, Hetts SW, et al. Utility of MRI in spinal arteriovenous fistula. Neurology. 2012;79(1):25-30.

  • 3

    Luetmer PH, Lane JI, Gilbertson JR, Bernstein MA, Huston J III, Atkinson JL. 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. 2005;26(4):711-718.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Saraf-Lavi E, Bowen BC, Quencer RM, et al. 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. 2002;23(5):858-867.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Lindenholz A, TerBrugge KG, van Dijk JM, Farb RI. The accuracy and utility of contrast-enhanced MR angiography for localization of spinal dural arteriovenous fistulas: the Toronto experience. Eur Radiol. 2014;24(11):2885-2894.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Saindane AM, Boddu SR, Tong FC, Dehkharghani S, Dion JE. Contrast-enhanced time-resolved MRA for pre-angiographic evaluation of suspected spinal dural arterial venous fistulas. J Neurointerv Surg. 2015;7(2):135-140.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Brinjikji W, Hilditch CA, Morris JM, et al. Dilated vein of the filum terminale on MRI: a marker for deep lumbar and sacral dural and epidural arteriovenous fistulas. AJNR Am J Neuroradiol. 2018;39(10):1953-1956.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Mull M, Nijenhuis RJ, Backes WH, Krings T, Wilmink JT, Thron A. Value and limitations of contrast-enhanced MR angiography in spinal arteriovenous malformations and dural arteriovenous fistulas. AJNR Am J Neuroradiol. 2007;28(7):1249-1258.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Farb RI, Kim JK, Willinsky RA, et al. Spinal dural arteriovenous fistula localization with a technique of first-pass gadolinium-enhanced MR angiography: initial experience. Radiology. 2002;222(3):843-850.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Barreras P, Heck D, Greenberg B, Wolinsky JP, Pardo CA, Gailloud P. Analysis of 30 spinal angiograms falsely reported as normal in 18 patients with subsequently documented spinal vascular malformations. AJNR Am J Neuroradiol. 2017;38(9):1814-1819.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Takai K, Komori T, Taniguchi M. Microvascular anatomy of spinal dural arteriovenous fistulas: arteriovenous connections and their relationships with the dura mater. J Neurosurg Spine. 2015;23(4):526-533.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Kannath SK, Alampath P, Enakshy Rajan J, Thomas B, Sankara Sarma P, Tirur Raman K. Utility of 3D SPACE T2-weighted volumetric sequence in the localization of spinal dural arteriovenous fistula. J Neurosurg Spine. 2016;25(1):125-132.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    El Mekabaty A, Pardo CA, Gailloud P. The yield of initial conventional MRI in 115 cases of angiographically confirmed spinal vascular malformations. J Neurol. 2017;264(4):733-739.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Brinjikji W, Nasr DM, Morris JM, Rabinstein AA, Lanzino G. Clinical outcomes of patients with delayed diagnosis of spinal dural arteriovenous fistulas. AJNR Am J Neuroradiol. 2016;37(2):380-386.

    • PubMed
    • Search Google Scholar
    • Export Citation

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