Spinal dural arteriovenous fistulas: MR and myelographic findings

J. R. Gilbertson, G. M. Miller, M. S. Goldman, W. R. Marsh

Research output: Contribution to journalArticle

173 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)2049-2057
Number of pages9
JournalAmerican Journal of Neuroradiology
Volume16
Issue number10
StatePublished - 1995

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Central Nervous System Vascular Malformations
Angiography
Spinal Cord Diseases
Sacrum
Myelography
Vascular Malformations
Hypesthesia
Gadolinium
Fistula
Spinal Cord
Pain

Keywords

  • Fistula, arteriovenous
  • Fistula, spinal dural
  • Spinal cord, magnetic resonance

ASJC Scopus subject areas

  • Clinical Neurology
  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

Cite this

Gilbertson, J. R., Miller, G. M., Goldman, M. S., & Marsh, W. R. (1995). Spinal dural arteriovenous fistulas: MR and myelographic findings. American Journal of Neuroradiology, 16(10), 2049-2057.

Spinal dural arteriovenous fistulas : MR and myelographic findings. / Gilbertson, J. R.; Miller, G. M.; Goldman, M. S.; Marsh, W. R.

In: American Journal of Neuroradiology, Vol. 16, No. 10, 1995, p. 2049-2057.

Research output: Contribution to journalArticle

Gilbertson, JR, Miller, GM, Goldman, MS & Marsh, WR 1995, 'Spinal dural arteriovenous fistulas: MR and myelographic findings', American Journal of Neuroradiology, vol. 16, no. 10, pp. 2049-2057.
Gilbertson JR, Miller GM, Goldman MS, Marsh WR. Spinal dural arteriovenous fistulas: MR and myelographic findings. American Journal of Neuroradiology. 1995;16(10):2049-2057.
Gilbertson, J. R. ; Miller, G. M. ; Goldman, M. S. ; Marsh, W. R. / Spinal dural arteriovenous fistulas : MR and myelographic findings. In: American Journal of Neuroradiology. 1995 ; Vol. 16, No. 10. pp. 2049-2057.
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abstract = "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.",
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AU - Gilbertson, J. R.

AU - Miller, G. M.

AU - Goldman, M. S.

AU - Marsh, W. R.

PY - 1995

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N2 - 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.

AB - 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.

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KW - Fistula, spinal dural

KW - Spinal cord, magnetic resonance

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