Abstract
Spinal epidural AVFs are rare spinal vascular malformations. When there is associated intradural venous reflux, they may mimic the more common spinal dural AVFs. Correct diagnosis and localization before conventional angiography is beneficial to facilitate treatment. We hypothesize that first-pass contrast-enhanced MRA can diagnose and localize spinal epidural AVFs with intradural venous reflux and distinguish them from other spinal AVFs. Forty-two consecutive patients with a clinical and/or radiologic suspicion of spinal AVF underwent MR imaging, first-pass contrast-enhanced MRA, and DSA at a single institute (2000-2015). MR imaging/MRA and DSA studies were reviewed by 2 independent blinded observers. DSA was used as the reference standard. On MRA, all 7 spinal epidural AVFs with intradural venous reflux were correctly diagnosed and localized with no interobserver disagreement. The key diagnostic feature was arterialized filling of an epidural venous pouch with a refluxing radicular vein arising from the arterialized epidural venous system. First-pass contrast-enhanced MRA is a reliable and useful technique for the initial diagnosis and localization of spinal epidural AVFs with intradural venous reflux and can distinguish these lesions from other spinal AVFs.
Highlights
BACKGROUND AND PURPOSESpinal epidural AVFs are rare spinal vascular malformations
The key diagnostic feature was arterialized filling of an epidural venous pouch with a refluxing radicular vein arising from the arterialized epidural venous system
Compared with spinal dural AVFs (SDAVFs), the angioarchitecture of spinal epidural AVFs (SEAVFs) with intradural reflux is usually more complex, with the radicular vein arising from the arterialized epidural venous system and with a greater likelihood of multiple arterial feed
Summary
The purpose of this study was to evaluate the performance of first-pass contrast-enhanced MRA to diagnose and localize SEAVFs with intradural venous reflux and distinguish them from other spinal AVFs by using DSA as the criterion standard
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