Analysis of 30 Spinal Angiograms Falsely Reported as Normal in 18 Patients with Subsequently Documented Spinal Vascular Malformations

66-year-old woman (patient 15) with a right T10 SDAVF and 1 prior negative spinal angiogram. A, DSA, nonselective injection at the T9 level, posteroanterior view, arterial phase (first study). The right T10 intersegmental artery supplies an arteriovenous shunt with early opacification of perimedullary venous structures (arrow). The anomaly was not detected. B, DSA, right T10 injection, posteroanterior view, arterial phase (second study). Selective angiography confirms the presence of an SDAVF fed by the right T10 radicular artery (arrowhead) and documents its extensive perimedullary drainage (arrow).

60-year-old man (patient 5) with a right T4 SDAVF and 1 prior negative angiogram. The patient consulted for a second opinion after substantial clinical pejoration during intravenous steroid therapy. A, DSA, right T4 injection, posteroanterior view, arterial phase (first study). A midline vessel (arrows) was noted but interpreted as being the anterior spinal artery. B, DSA, right T4 injection, posteroanterior view, arterial phase (second study). A right T4 radiculomeningeal branch (white arrowhead) supplies an arteriovenous shunt draining into a posterior radiculomedullary vein (black arrowhead) and the posterior-median spinal vein (black arrows).