Abstract

Catheter angiography is typically used for follow-up of treated spinal AVFs. The purpose of this study was to determine the diagnostic performance and utility of first-pass contrast-enhanced MRA in the posttreatment evaluation of spinal AVFs compared with DSA. A retrospective review was performed of all patients at our tertiary referral hospital (from January 2000 to April 2015) who underwent spine MR imaging, first-pass contrast-enhanced MRA, and DSA after surgical and/or endovascular treatment of a spinal AVF. Presence of recurrent or residual fistula on MRA, including vertebral level of the recurrent/residual fistula, was evaluated by 2 experienced neuroradiologists blinded to DSA findings. Posttreatment conventional MR imaging findings were also evaluated, including presence of intramedullary T2 hyperintensity, perimedullary serpentine flow voids, and cord enhancement. The performance of MRA and MR imaging findings for diagnosis of recurrent/residual fistula was determined by using DSA as the criterion standard. In total, 28 posttreatment paired MR imaging/MRA and DSA studies were evaluated in 22 patients with prior spinal AVF and 1 patient with intracranial AVF with prior cervical perimedullary venous drainage. Six image sets of 5 patients demonstrated recurrent/residual disease at DSA. MRA correctly identified all cases with recurrent/residual disease with 1 false-positive (sensitivity, 100%; specificity 95%; P < .001), with correct localization in all cases without interobserver disagreement. Conventional MR imaging parameters were not significantly associated with recurrent/residual spinal AVF. First-pass MRA demonstrates high sensitivity and specificity for identifying recurrent/residual spinal AVFs and may potentially substitute for DSA in the posttreatment follow-up of patients with spinal AVFs.

Highlights

  • BACKGROUND AND PURPOSECatheter angiography is typically used for follow-up of treated spinal AVFs

  • Similar clinical and radiologic appearances can occur with intracranial dural fistulas draining into the spinal venous system, epidural fistulas with intrathecal venous reflux as well as perimedullary and filum terminale fistulas

  • Prevalence of recurrent or residual fistulas after treatment of SAVFs ranges from 3.4% to 27.8% and is associated with progressive myelopathy and morbidity.[1]

Read more

Summary

Objectives

The purpose of this study was to determine the diagnostic performance and utility of first-pass contrast-enhanced MRA in the posttreatment evaluation of spinal AVFs compared with DSA

Methods
Results
Discussion
Conclusion

Talk to us

Join us for a 30 min session where you can share your feedback and ask us any queries you have

Schedule a call

Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.