Time-Resolved Magnetic Resonance Angiography for Follow-Up of Treated Dural and Epidural Spinal Arteriovenous Fistula

Abstract

Background Spinal arteriovenous fistulas (AVFs) are uncommon vascular malformations of spinal dural and epidural vessels. Actually digital subtraction angiography (DSA) is the gold standard for diagnosis and follow-up. The aim of this study is to demonstrate the validity of the multiphasic magnetic resonance angiography (MRA) to identify recurrent/residual AVFs or their correct surgical and/or endovascular closure.

Methods A retrospective cases series with perimedullary venous plexus congestion due to spinal dural or epidural AVF was performed at our center from April 2014 to September 2019. After 1 month from treatment, the patients were subjected to time-resolved MRA and DSA to demonstrate recurrence or correct closure of AVFs.

Results We collected a series of 26 matched time-resolved MRA and DSA in 20 patients who underwent an endovascular and/or surgical procedure. In our series, we reported five cases of recurrence. Time-resolved MRA detected six cases of recurrence, with 100% sensitivity and 95% specificity (p < 0.001). We used DSA as the standard reference.

Conclusion Time-resolved MRA is a valid tool in posttreatment follow-up to detect recurrent or residual AVFs. It has high sensitivity and specificity and may replace DSA.

Keywords

arteriovenous fistula - spine vascular malformations - magnetic resonance angiography - multiphasic MRA - time resolved MRA

Publication History

Received: 08 July 2020

Accepted: 25 May 2021

Article published online:
15 December 2021

• References

• 1 Fugate JE, Lanzino G, Rabinstein AA. Clinical presentation and prognostic factors of spinal dural arteriovenous fistulas: an overview. Neurosurg Focus 2012; 32 (05) E17
• 2 Orru' E, Sorte DE, Wolinsky JP. et al. Intraoperative spinal digital subtraction angiography: indications, technique, safety, and clinical impact. J Neurointerv Surg 2017; 9 (06) 601-607
• 3 Morris JM, Kaufmann TJ, Campeau NG, Cloft HJ, Lanzino G. Volumetric myelographic magnetic resonance imaging to localize difficult-to-find spinal dural arteriovenous fistulas. J Neurosurg Spine 2011; 14 (03) 398-404
• 4 Ali S, Cashen TA, Carroll TJ. et al. Time-resolved spinal MR angiography: initial clinical experience in the evaluation of spinal arteriovenous shunts. AJNR Am J Neuroradiol 2007; 28 (09) 1806-1810
• 5 Spetzler RF, Detwiler PW, Riina HA, Porter RW. Modified classification of spinal cord vascular lesions. J Neurosurg 2002; 96 (2, Suppl): 145-156
• 6 Kim LJ, Spetzler RF. Classification and surgical management of spinal arteriovenous lesions: arteriovenous fistulae and arteriovenous malformations. Neurosurgery 2006; 59 (5, Suppl 3): discussion S3–S13 S195-S201
• 7 Goyal A, Cesare J, Lu VM. et al. Outcomes following surgical versus endovascular treatment of spinal dural arteriovenous fistula: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 2019; 90 (10) 1139-1146
• 8 Sorenson T, Giordan E, Cannizzaro D, Lanzino G. Surgical ligation of spinal dural arteriovenous fistula. Acta Neurochir (Wien) 2018; 160 (01) 191-194
• 9 Korosec FR, Frayne R, Grist TM, Mistretta CA. Time-resolved contrast-enhanced 3D MR angiography. Magn Reson Med 1996; 36 (03) 345-351
• 10 Sprent P. Fisher exact test. In: Lovric M. ed. International Encyclopedia of Statistical Science. Berlin: Springer; 2011: 524-525
• 11 Mathur S, Symons SP, Huynh TJ, Marotta TR, Aviv RI, Bharatha A. First-pass contrast-enhanced MR angiography in evaluation of treated spinal arteriovenous fistulas: is catheter angiography necessary?. AJNR Am J Neuroradiol 2017; 38 (01) 200-205
• 12 Mathur S, Bharatha A, Huynh TJ, Aviv RI, Symons SP. Comparison of time-resolved and first-pass contrast-enhanced MR angiography in pretherapeutic evaluation of spinal dural arteriovenous fistulas. AJNR Am J Neuroradiol 2017; 38 (01) 206-212
• 13 Kannath SK, Thomas B, Sankara Sarma P, Enakshy Rajan J. Impact of non-contrast enhanced volumetric MRI-based feeder localization in the treatment of spinal dural arteriovenous fistula. J Neurointerv Surg 2017; 9 (02) 178-182
• 14 Koizumi S, Takai K, Shojima M. et al. Spinal extradural arteriovenous fistulas with retrograde intradural venous drainage: diagnostic features in digital subtraction angiography and time-resolved magnetic resonance angiography. J Clin Neurosci 2017; 45: 276-281