Article Figures & Data
Figures
- Fig 1.
Spinal epidural AVF with intradural venous drainage (patient 4). Sagittal T2, postgadolinium T1, MRA MIP, and frontal DSA images pretreatment (A1–4), after first attempted surgical disconnection (B1–4), and after second surgical disconnection (C1–4), respectively. Pretreatment study shows T2 cord hyperintensity and enhancement (A1–2, arrowheads) with surrounding enhancing perimedullary flow voids (A1–2, arrows). MRA shows arterial enhancement of intradural veins (A3, arrow). DSA confirmed the AVF (A4, arrow indicates the arterialized radicular vein). Postsurgical study after attempted AVF disconnection (B1–4) shows findings unchanged compared with the pretreatment study, consistent with residual AVF. Second postsurgical study shows persistent T2 cord hyperintensity and enhancement (C1–2, arrowheads) with decreased size of perimedullary veins (C1–2, arrows). MRA and DSA (C3–4) confirm absence of arterialized intradural veins, consistent with a successful surgical disconnection.
- Fig 2.
Spinal dural AVF in a 50-year-old man with 6 months of progressive lower extremity paraplegia. Pretreatment sagittal T2 (A) and postcontrast T1 (B) show abnormal perimedullary vessels (A, arrow), which enhance postcontrast (B, arrow), in addition to intramedullary T2 hyperintensity (A, arrowheads) with mild patchy intramedullary enhancement (B, arrowheads). Pretreatment sagittal MRA MIP (C) demonstrates arterially enhancing perimedullary veins (C, arrow). Right L1 segmental artery injection–frontal projection DSA demonstrates retrograde drainage into radicular vein (D, arrow). After surgical disconnection, there is reduction in intramedullary T2 hyperintensity (E, arrowheads) and perimedullary flow voids, with persistent cord enhancement (F, arrowheads) and lack of arterially enhancing perimedullary veins on MRA (G). Successful fistula disconnection was confirmed on repeat DSA (H).
- Fig 3.
False-positive on MRA. 78-year-old man with prior surgical disconnection of a spinal dural AVF at left T5 level presented with worsening gait spasticity confounded by history of Parkinson disease. Few dorsal perimedullary flow voids were noted on the sagittal T2 (A, arrow), which enhanced on the postcontrast T1 study (B, arrow). Mild intramedullary enhancement was also noted on the postcontrast T1 (B, arrowhead). On MRA (C), there was faint enhancement of the perimedullary veins (C, arrow), which led to the suspicion of residual/recurrent fistula. No fistula was found at subsequent DSA (not shown). The findings on MR imaging and MRA were presumed to be residual changes from prior fistula. Mild enhancement of the perimedullary veins may be a result of venous contamination of contrast bolus, as suggested by enhancement of the basivertebral veins (C, arrowhead).
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