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Reliability of CE MRA for the diagnosis of SDAVF 2012

General Spine

Richard, I, Farb, MD

Paper/Non-Mentor

Purpose

The use of gadolinium enhanced elliptic centric encoded MRA for the diagnosis and localization of spinal dural arteriovenous fistula (SDAVF) was first published in 2002. That initial experience of ten patients suggested that that CE MRA was a valuable tool for the work-up of these patients. With this study we retrospectively review the subsequent experience at our institution using CEMRA for evaluation of patients suspected of harboring a SDAVF.

Methods & Materials

IRB approval for this retrospective review was obtained. We reviewed our local database to identify patients referred for suspected SDAVF. Each patient included in the study underwent, at our institution, an initial screening MR/MRA of the spine and subsequent fistula confirming IADSA. The reports of each MR/ MRA were reviewed and results were tabulated noting the suspected absence or presence and specified location of a SDAVF. These interpretations were then compared to the "gold standard "of the patients IADSA results. MR images of the confirmed cases were also reviewed for presence of spinal cord edema, swelling and enhancement as well as presence of intradural peri-medullary tortuous vascular flow voids.

Results

Between July 2002 and Sept 2011, 124 CE MRA screening exams for SDAVF were performed at our institution .A total of 51 patients had the usual clinical presentation and MR findings and also underwent CEMRA which preceded a diagnostic IADSA showing the fistula. In 40 of these 51 cases (78%) the CE MRA correctly and precisely localized the site of the SDAVF prior to DSA. In 11 cases (22%) the site of the fistula could not be seen or was localized incorrectly. In 100% of cases of SDAVF dilated peri-medullary venous plexus was appreciated on the pre-angiogram MR, 96% showed edema, 94% showed swelling and 94% showed enhancement of the spinal cord.

Conclusion

Contrast-enhanced elliptic centric encoded MR angiography of the spine is a valuable tool in the workup of patient suspected of harboring SDAVF correctly identifying the site of the fistula in 78% of patients prior to angiography. Presumed reasons for failure of the technique in 22% of cases will be reviewed.

References/Financial Disclosures

Spinal dural arteriovenous fistula localization with a technique of first-pass gadolinium-enhanced MR angiography: Initial experience. Farb RI ; Kim JK ; Willinsky RA ; et al. RADIOLOGY Volume: 222 Issue: 3 Pages: 843-850

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