Role of Contrast-Enhanced Magnetic Resonance Angiography in Spinal Dural Arteriovenous Fistula

BackgroundThe preoperative localization of the feeder of spinal dural arteriovenous fistula (SDAVF) could simplify the diagnostic spinal angiographic procedure. Localization by non-contrast-enhanced MRI-based techniques is an attractive option. However, the usefulness of such an approach for evaluation of SDAVF has not yet been reported.ObjectiveTo study the impact of non-contrast MRI-based feeder localization, followed by targeted spinal angiography, in the evaluation of SDAVF before endovascular intervention.Materials and methodsProspectively collected data were analyzed and the level of the feeder was localized preoperatively. The procedural time for targeted spinal angiography was calculated and compared with that of a historical cohort, who underwent routine spinal angiographic examination before the study period. Follow-up MRI was carried out to assess the reliability of this model for detection of occasional metachronous lesions that might be missed with this approach.ResultsSeven patients underwent targeted spinal angiography during the study. The feeder level was accurately identified in five patients and was localized to one vertebral level in six patients. The correlation between MRI and DSA was statistically significant. The number of spinal levels assessed was fewer and overall procedure time was significantly shorter compared to historical cohort (58 min vs 162 min, respectively; p<0.001). Intervention was coupled with targeted angiography in two patients. Follow-up MRI demonstrated flow voids in one patient, who had recurrent fistula at one vertebral level below the previously embolized feeder.ConclusionsThe non-contrast MRI-based localization technique can reliably detect the level of feeder and help in therapeutic planning of SDAVF. The localization techniques potentially shorten the angiographic procedure and may facilitate simultaneous endovascular definitive treatment. Inclusion of follow-up MRI may be useful for detection of synchronous or metachronous lesions if a targeted approach is adopted. Additionally, this helps to identify failed endovascular therapy.

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Patient Outcomes Following Obliteration of Spinal Dural Arteriovenous Fistula and the Role of Indocyanine Green Angiography Videoangiography (ICG‑VA) During Surgery

Neurology India ◽

10.4103/0028-3886.279705 ◽

2020 ◽

Vol 68 (1) ◽

pp. 118

Author(s):

Manoj Phalak ◽

Venkat Koyalmantham ◽

ShashankSharad Kale ◽

LeveJoseph Devarajan ◽

PSarat Chandra ◽

...

Keyword(s):

Indocyanine Green ◽

Arteriovenous Fistula ◽

Patient Outcomes ◽

Indocyanine Green Angiography ◽

Dural Arteriovenous Fistula ◽

Spinal Dural Arteriovenous Fistula

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Infantile Hepatic Hemangioma: Role of Dynamic Contrast-Enhanced Magnetic Resonance Angiography

The Journal of Pediatrics ◽

10.1016/j.jpeds.2015.06.068 ◽

2015 ◽

Vol 167 (4) ◽

pp. 940-940.e1 ◽

Cited By ~ 1

Author(s):

Nishant Aggarwal ◽

Aylin Tekes ◽

Thangamadhan Bosemani

Keyword(s):

Magnetic Resonance ◽

Magnetic Resonance Angiography ◽

Hepatic Hemangioma ◽

Dynamic Contrast Enhanced ◽

Contrast Enhanced

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Role of CISS MR sequence in detection of spinal dural arteriovenous fistula

Clinical Radiology Extra ◽

10.1016/j.cradex.2004.03.004 ◽

2004 ◽

Vol 59 (8) ◽

pp. 78-82 ◽

Cited By ~ 3

Author(s):

T Rizvi ◽

A Garg ◽

V Gupta ◽

S.B Gaikwad ◽

N.K Mishra

Keyword(s):

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

Spinal Dural Arteriovenous Fistula

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Dilated MMA sign in cDAVF and other arterial feeders on 3D TOF MRA

The Neuroradiology Journal ◽

10.1177/19714009211041530 ◽

2021 ◽

pp. 197140092110415

Author(s):

Sin Y Foo ◽

Saravana K Swaminathan ◽

Timo Krings

Keyword(s):

Magnetic Resonance ◽

Magnetic Resonance Angiography ◽

Confidence Interval ◽

Arteriovenous Fistula ◽

Digital Subtraction Angiography ◽

Dural Arteriovenous Fistula ◽

Middle Meningeal Artery ◽

Digital Subtraction ◽

Meningeal Artery ◽

Meningohypophyseal Trunk

Background Among the varied causes of pulsatile tinnitus, the condition that can cause severe mortality and morbidity is a cranial dural arteriovenous fistula (cDAVF). This study aimed to assess the diagnostic accuracy of the dilated middle meningeal artery on three-dimensional time-of-flight magnetic resonance angiography in cranial dural arteriovenous fistula and to identify other feeders that can aid in the detection of these lesions. Method Magnetic resonance angiography and digital subtraction angiography data of all patients with cranial dural arteriovenous fistula treated in a single tertiary referral center between 2007–2020 were included. The middle meningeal artery and other feeders recorded from digital subtraction angiography were assessed on magnetic resonance angiography. Results The overall agreement between readers in identifying the dilated middle meningeal artery was substantial (κ = 0.878, 95% confidence interval: 0.775–0.982). The dilated middle meningeal artery indicated the presence of a cranial dural arteriovenous fistula with a sensitivity of 79.49% (95% confidence interval: 66.81–92.16), specificity of 100% (95% confidence interval: 100.00–100.00), and negative predictive value of 94.56% (95% confidence interval: 90.89–98.02). An area under the curve of 0.8341 was observed for the ipsilateral middle meningeal artery, with a sensitivity of 92.2% and a specificity of 75.0% at a cut-off of 0.30 mm for identifying a cranial dural arteriovenous fistula. Of 73 other feeders, the occipital, meningohypophyseal trunk, ascending pharyngeal, and posterior meningeal arteries contributed to a large proportion visualized on magnetic resonance angiography (83.6% (41/49)). Conclusion The dilated middle meningeal artery sign is useful for identifying a cranial dural arteriovenous fistula. Dilatation of the occipital and ascending pharyngeal arteries and meningohypophyseal trunk should be assessed to facilitate the detection of a cranial dural arteriovenous fistula, particularly in the transverse-sigmoid and petrous regions.

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