Lindenholz, A. (Arjen) (2012) Spinal Dural Arterio-venous Fistulas : The Utility and Accuracy of Contrast-Enhanced MR Angiography for Localization of Spinal Dural Arteriovenous Fistulas. thesis, Medicine.
Full text available on request.Abstract
Background and purpose: Spinal Dural Arteriovenous Fistulas (SDAVFs) are challenging to diagnose. Often the diagnosis is made when advanced neurological symptoms are present. Radiological examination plays a key role in making the diagnosis. Conventional MR imaging may give raise to the suspicion of a SDAVF and contrast-enhanced MR angiography (CE-MRA) can serve as a useful non-invasive examination to detect SDAVFs and predict their location prior to digital subtraction angiography (DSA). Few experiences are published with CE-MRA but only in preliminary fashion or comprised small number of cases. By using CE-MRA as guidance for selective DSA, burdensome DSA can be avoided. The purpose of this study was to determine the utility and accuracy of contrast-enhanced MR angiography in Spinal Dural Arteriovenous Fistulas in a large number of cases. Methods: A retrospective analysis from 1999 – 2012 in the Toronto Western Hospital/University Health Network (TWH/UHN) identified 70 patients clinically suspected of harboring a SDAVF. Each patient underwent conventional MR imaging, CE-MRA and DSA. We evaluated for the presence or absence of serpentine flow voids, T2-weighted hyperintensity and patchy cord enhancement on conventional MR imaging as well as the level and side of the fistula as predicted by CE-MRA. DSA was used as the reference standard for the true location of the fistula. Institutional Research Ethic Board approval was obtained. Results: Of the 70 cases, 53 were determined to be a SDAVF, 10 cases were shown to be other forms of spinal vascular malformation and 7 were negative on DSA. On conventional MR imaging all reported cases of SDAVF showed serpentine flow voids (100%). T2-weighted hyperintensity was seen in 96% extending to the conus in 85% of cases. Patchy cord enhancement was seen in 93%. CE-MRA correctly localized the level and side of the SDAVF in 43 of the 53 cases (81%). Conclusion: CE-MRA is a useful non-invasive examination in the detection of the level and side of a SDAVF. A negative CE-MRA combined with negative conventional MR imaging can exclude a SDAVF and obviate the need for DSA. CE-MRA facilitates but does not replace diagnostic DSA in cases of SDAVF as confirmation of specific location, type of fistula and arterial detail are required prior to contemplated treatment of these lesions.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Dutch supervisor: and Dijk, Dr. JMC van MD PhD and GIPS-M supervisor: and Kallenberg, Prof. Dr. CGM MD PhD |
| Supervisor name: | Abroad supervisor 1: and Farb, dr. MD and Abroad supervisor 2: and TerBrugge, Prof. dr. K MD |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:44 |
| Last Modified: | 25 Jun 2020 10:44 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/548 |
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