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Spinal dural arteriovenous fistulas: MR and myelographic findings

Spinal dural arteriovenous fistulas: MR and myelographic findings This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Gilbertson, J. R. Articles by Marsh, W. R. Search for Related Content PubMed PubMed Citation Articles by Gilbertson, J. R. Articles by Marsh, W. R. Hotlight (NEW!) What's Hotlight? American Journal of Neuroradiology, Vol 16, Issue 10 2049-2057, Copyright © 1995 by American Society of Neuroradiology ARTICLES Spinal dural arteriovenous fistulas: MR and myelographic findings JR Gilbertson, GM Miller, MS Goldman and WR Marsh Department of Diagnostic Radiology, Mayo Clinic, Rochester, Minn. 55905, USA. PURPOSE: To examine the clinical and radiographic findings in a large group of patients having or suspected of having a spinal dural arteriovenous fistula. METHODS: An analysis of 240 spinal angiograms in 132 patients revealed 97 vascular malformations that included 66 spinal dural arteriovenous fistulas. Sixteen patients had 1 or more normal spinal angiograms that were performed for suspected spinal dural arteriovenous fistulas on other imaging studies. The imaging and clinical data were reviewed in all patients who had or were suspected of having a spinal dural arteriovenous fistula and who had a spinal MR (n = 44) and a myelogram (n = 37). RESULTS: Spinal dural arteriovenous fistulas were more common in males (3.4:1) with an average age of 62 years (range, 37 to 81 years). The average time from onset of symptoms to diagnosis was 27 months. Clinical findings included weakness (55%), a progressive clinical course (100%), and a myelopathy on exam (84%). The nidus of the fistula was located between T-6 and T-12 in 61%, in the sacrum in 9%, and intracranially in 8%. In the spinal dural arteriovenous fistula group, vessels were seen on supine myelography in all patients. MR findings in this group included increased T2 signal in the cord (100%), gadolinium enhancement (88%), mass effect (45%), and flow voids (T1, 35%; T2, 45%). The patients in the negative spinal angiogram group were younger (average age, 51 years), had symptoms longer (average time from symptom onset to spinal angiogram, 59 months), and presented with numbness or pain (76%). When compared with the patients with spinal dural arteriovenous fistula, acute or stable deficits were more common (31%), and myelopathy on exam was less common (56%). Although the angiogram-negative patients commonly had vessels on the myelogram (92%), abnormal T2 signal in the cord was unusual (17%). CONCLUSIONS: In the appropriate clinical setting, high T2 signal of the spinal cord is the most sensitive imaging finding in spinal dural arteriovenous fistula. The presence of mass effect and enhancement should not discourage this diagnosis. The likelihood of finding a spinal dural arteriovenous fistula in a patient without T2 signal on MR is low. This article has been cited by other articles: T. Krings and S. Geibprasert Spinal Dural Arteriovenous Fistulas AJNR Am. J. Neuroradiol., April 1, 2009; 30(4): 639 - 648. Abstract Full Text PDF S. Ali, T.A. Cashen, T.J. Carroll, E. McComb, M. Muzaffar, A. Shaibani, and M.T. Walker Time-Resolved Spinal MR Angiography: Initial Clinical Experience in the Evaluation of Spinal Arteriovenous Shunts AJNR Am. J. Neuroradiol., October 1, 2007; 28(9): 1806 - 1810. Abstract Full Text PDF K. Jellema, C. C. Tijssen, and J. v. Gijn Spinal dural arteriovenous fistulas: a congestive myelopathy that initially mimics a peripheral nerve disorder Brain, December 1, 2006; 129(12): 3150 - 3164. Abstract Full Text PDF P.H. Lai, M.J. Weng, K.W. Lee, and H.B. Pan Multidetector CT angiography in diagnosing type I and type IVA spinal vascular malformations. AJNR Am. J. Neuroradiol., April 1, 2006; 27(4): 813 - 817. Abstract Full Text PDF K. D. Nelson and C. C. Roberts AJR Teaching File: Progressive Myelopathy. Am. J. Roentgenol., March 1, 2006; 186(3 Suppl): S227 - S229. Full Text PDF P. H. Luetmer, J. I. Lane, J. R. Gilbertson, M. A. Bernstein, J. Huston III, and J. L. D. Atkinson Preangiographic Evaluation of Spinal Dural Arteriovenous Fistulas with Elliptic Centric Contrast-Enhanced MR Angiography and Effect on Radiation Dose and Volume of Iodinated Contrast Material AJNR Am. J. Neuroradiol., April 1, 2005; 26(4): 711 - 718. Abstract Full Text PDF N. A. Chuang, M. M. Shroff, R. A. Willinsky, J. M. Drake, P. B. Dirks, and D. C. Armstrong Slow-Flow Spinal Epidural AVF with Venous Ectasias: Two Pediatric Case Reports AJNR Am. J. Neuroradiol., October 1, 2003; 24(9): 1901 - 1905. Abstract Full Text PDF E. Saraf-Lavi, B. C. Bowen, R. M. Quencer, E. M.L. Sklar, A. Holz, S. Falcone, R. E. Latchaw, R. Duncan, and A. Wakhloo Detection of Spinal Dural Arteriovenous Fistulae with MR Imaging and Contrast-Enhanced MR Angiography: Sensitivity, Specificity, and Prediction of Vertebral Level AJNR Am. J. Neuroradiol., May 1, 2002; 23(5): 858 - 867. Abstract Full Text PDF N Ramli, A Cooper, and T Jaspan High resolution CISS imaging of the spine Br. J. Radiol., September 1, 2001; 74(885): 862 - 873. Abstract Full Text PDF An unusual cause of paraplegia Postgrad. Med. J., July 1, 2001; 77(909): 481a - 481. Full Text PDF S. Kastenbauer, F. Winkler, G. Fesl, X. Schiel, H. Ostermann, T. A. Yousry, and H. W. Pfister Acute Severe Spinal Cord Dysfunction in Bacterial Meningitis in Adults: MRI Findings Suggest Extensive Myelitis Arch Neurol, May 1, 2001; 58(5): 806 - 810. Abstract Full Text PDF M. Mascalchi, G. Ferrito, N. Quilici, S. Mangiafico, M. Cosottini, M. Cellerini, L. S. Politi, L. Guerrini, C. Bartolozzi, and N. Villari Spinal Vascular Malformations: MR Angiography after Treatment Radiology, May 1, 2001; 219(2): 346 - 353. Abstract Full Text R. W. Hurst and R. I. Grossman Peripheral Spinal Cord Hypointensity on T2-weighted MR Images: A Reliable Imaging Sign of Venous Hypertensive Myelopathy AJNR Am. J. Neuroradiol., April 1, 2000; 21(4): 781 - 786. Abstract Full Text R. M. Quencer The American Journal of Neuroradiology 1980-1999 Where We Have Been: Where We Are Going AJNR Am. J. Neuroradiol., January 1, 2000; 21(1): 1 - 8. Full Text R. I. Farb, J. K. Kim, R. A. Willinsky, W. J. Montanera, K. terBrugge, J. A. Derbyshire, J. M. C. van Dijk, and G. A. Wright Spinal Dural Arteriovenous Fistula Localization with a Technique of First-Pass Gadolinium-enhanced MR Angiography: Initial Experience Radiology, March 1, 2002; 222(3): 843 - 850. Abstract Full Text PDF Home Subscribe Author Instructions Submit Online Search the AJNR Archives Feedback Help Copyright © 2010 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Neuroradiology American Journal of Neuroradiology

Spinal dural arteriovenous fistulas: MR and myelographic findings

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Publisher
American Journal of Neuroradiology
Copyright
Copyright © 2010 by the American Society of Neuroradiology.
ISSN
0195-6108
eISSN
1936-959X
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Abstract

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Gilbertson, J. R. Articles by Marsh, W. R. Search for Related Content PubMed PubMed Citation Articles by Gilbertson, J. R. Articles by Marsh, W. R. Hotlight (NEW!) What's Hotlight? American Journal of Neuroradiology, Vol 16, Issue 10 2049-2057, Copyright © 1995 by American Society of Neuroradiology ARTICLES Spinal dural arteriovenous fistulas: MR and myelographic findings JR Gilbertson, GM Miller, MS Goldman and WR Marsh Department of Diagnostic Radiology, Mayo Clinic, Rochester, Minn. 55905, USA. PURPOSE: To examine the clinical and radiographic findings in a large group of patients having or suspected of having a spinal dural arteriovenous fistula. METHODS: An analysis of 240 spinal angiograms in 132 patients revealed 97 vascular malformations that included 66 spinal dural arteriovenous fistulas. Sixteen patients had 1 or more normal spinal angiograms that were performed for suspected spinal dural arteriovenous fistulas on other imaging studies. The imaging and clinical data were reviewed in all patients who had or were suspected of having a spinal dural arteriovenous fistula and who had a spinal MR (n = 44) and a myelogram (n = 37). RESULTS: Spinal dural arteriovenous fistulas were more common in males (3.4:1) with an average age of 62 years (range, 37 to 81 years). The average time from onset of symptoms to diagnosis was 27 months. Clinical findings included weakness (55%), a progressive clinical course (100%), and a myelopathy on exam (84%). The nidus of the fistula was located between T-6 and T-12 in 61%, in the sacrum in 9%, and intracranially in 8%. In the spinal dural arteriovenous fistula group, vessels were seen on supine myelography in all patients. MR findings in this group included increased T2 signal in the cord (100%), gadolinium enhancement (88%), mass effect (45%), and flow voids (T1, 35%; T2, 45%). The patients in the negative spinal angiogram group were younger (average age, 51 years), had symptoms longer (average time from symptom onset to spinal angiogram, 59 months), and presented with numbness or pain (76%). When compared with the patients with spinal dural arteriovenous fistula, acute or stable deficits were more common (31%), and myelopathy on exam was less common (56%). Although the angiogram-negative patients commonly had vessels on the myelogram (92%), abnormal T2 signal in the cord was unusual (17%). CONCLUSIONS: In the appropriate clinical setting, high T2 signal of the spinal cord is the most sensitive imaging finding in spinal dural arteriovenous fistula. The presence of mass effect and enhancement should not discourage this diagnosis. The likelihood of finding a spinal dural arteriovenous fistula in a patient without T2 signal on MR is low. This article has been cited by other articles: T. Krings and S. Geibprasert Spinal Dural Arteriovenous Fistulas AJNR Am. J. Neuroradiol., April 1, 2009; 30(4): 639 - 648. Abstract Full Text PDF S. Ali, T.A. Cashen, T.J. Carroll, E. McComb, M. Muzaffar, A. Shaibani, and M.T. Walker Time-Resolved Spinal MR Angiography: Initial Clinical Experience in the Evaluation of Spinal Arteriovenous Shunts AJNR Am. J. Neuroradiol., October 1, 2007; 28(9): 1806 - 1810. Abstract Full Text PDF K. Jellema, C. C. Tijssen, and J. v. Gijn Spinal dural arteriovenous fistulas: a congestive myelopathy that initially mimics a peripheral nerve disorder Brain, December 1, 2006; 129(12): 3150 - 3164. Abstract Full Text PDF P.H. Lai, M.J. Weng, K.W. Lee, and H.B. Pan Multidetector CT angiography in diagnosing type I and type IVA spinal vascular malformations. AJNR Am. J. Neuroradiol., April 1, 2006; 27(4): 813 - 817. Abstract Full Text PDF K. D. Nelson and C. C. Roberts AJR Teaching File: Progressive Myelopathy. Am. J. Roentgenol., March 1, 2006; 186(3 Suppl): S227 - S229. Full Text PDF P. H. Luetmer, J. I. Lane, J. R. Gilbertson, M. A. Bernstein, J. Huston III, and J. L. D. Atkinson Preangiographic Evaluation of Spinal Dural Arteriovenous Fistulas with Elliptic Centric Contrast-Enhanced MR Angiography and Effect on Radiation Dose and Volume of Iodinated Contrast Material AJNR Am. J. Neuroradiol., April 1, 2005; 26(4): 711 - 718. Abstract Full Text PDF N. A. Chuang, M. M. Shroff, R. A. Willinsky, J. M. Drake, P. B. Dirks, and D. C. Armstrong Slow-Flow Spinal Epidural AVF with Venous Ectasias: Two Pediatric Case Reports AJNR Am. J. Neuroradiol., October 1, 2003; 24(9): 1901 - 1905. Abstract Full Text PDF E. Saraf-Lavi, B. C. Bowen, R. M. Quencer, E. M.L. Sklar, A. Holz, S. Falcone, R. E. Latchaw, R. Duncan, and A. Wakhloo Detection of Spinal Dural Arteriovenous Fistulae with MR Imaging and Contrast-Enhanced MR Angiography: Sensitivity, Specificity, and Prediction of Vertebral Level AJNR Am. J. Neuroradiol., May 1, 2002; 23(5): 858 - 867. Abstract Full Text PDF N Ramli, A Cooper, and T Jaspan High resolution CISS imaging of the spine Br. J. Radiol., September 1, 2001; 74(885): 862 - 873. Abstract Full Text PDF An unusual cause of paraplegia Postgrad. Med. J., July 1, 2001; 77(909): 481a - 481. Full Text PDF S. Kastenbauer, F. Winkler, G. Fesl, X. Schiel, H. Ostermann, T. A. Yousry, and H. W. Pfister Acute Severe Spinal Cord Dysfunction in Bacterial Meningitis in Adults: MRI Findings Suggest Extensive Myelitis Arch Neurol, May 1, 2001; 58(5): 806 - 810. Abstract Full Text PDF M. Mascalchi, G. Ferrito, N. Quilici, S. Mangiafico, M. Cosottini, M. Cellerini, L. S. Politi, L. Guerrini, C. Bartolozzi, and N. Villari Spinal Vascular Malformations: MR Angiography after Treatment Radiology, May 1, 2001; 219(2): 346 - 353. Abstract Full Text R. W. Hurst and R. I. Grossman Peripheral Spinal Cord Hypointensity on T2-weighted MR Images: A Reliable Imaging Sign of Venous Hypertensive Myelopathy AJNR Am. J. Neuroradiol., April 1, 2000; 21(4): 781 - 786. Abstract Full Text R. M. Quencer The American Journal of Neuroradiology 1980-1999 Where We Have Been: Where We Are Going AJNR Am. J. Neuroradiol., January 1, 2000; 21(1): 1 - 8. Full Text R. I. Farb, J. K. Kim, R. A. Willinsky, W. J. Montanera, K. terBrugge, J. A. Derbyshire, J. M. C. van Dijk, and G. A. Wright Spinal Dural Arteriovenous Fistula Localization with a Technique of First-Pass Gadolinium-enhanced MR Angiography: Initial Experience Radiology, March 1, 2002; 222(3): 843 - 850. Abstract Full Text PDF Home Subscribe Author Instructions Submit Online Search the AJNR Archives Feedback Help Copyright © 2010 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X

Journal

American Journal of NeuroradiologyAmerican Journal of Neuroradiology

Published: Nov 1, 1995

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