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Spinal Vascular Malformations: MR Angiography after Treatment¹

¹ From the Department of Clinical Pathophysiology, Section of Radiodiagnostics, University of Florence, Viale Morgagni 85, 50134 Florence, Italy (M.M., M. Cellerini, L.S.P., L.G., N.V.); Department of Neuroradiology, Hospital Riuniti, Livorno, Italy (G.F., N.Q.); Department of Neuroradiology, Hospital of Careggi, Florence, Italy (S.M.); and Department of Radiology, University of Pisa, Italy (M. Cosottini, C.B.). Received April 25, 2000; revision requested June 12; revision received July 28; accepted August 30. Address correspondence to M.M.

PURPOSE: To evaluate the role of magnetic resonance (MR) angiography in the assessment of spinal vascular malformation therapy.

MATERIALS AND METHODS: Thirty-four patients with spinal vascular malformations (30 dural arteriovenous fistulas, two perimedullary arteriovenous fistulas, and two intramedullary arteriovenous malformations) underwent MR angiography and MR imaging before and after endovascular or surgical treatment.

RESULTS: MR angiography showed residual flow in perimedullary vessels in seven patients with dural fistula after embolization with liquid adhesive. In all seven, treatment failure was confirmed with arteriography. Long-lasting disappearance of flow in perimedullary vessels was demonstrated at MR angiography in 22 patients with dural fistula. MR imaging demonstrated normalization of spinal cord volume in 16 of 22 patients and signal intensity on T2-weighted images in three patients. Disappearance of cord enhancement was observed in five of 21 patients and of perimedullary enhanced vessels in six of 13 patients. In one additional patient with dural fistula treated with embolization, early posttreatment MR angiography showed disappearance of flow in perimedullary vessels, which reappeared at follow-up and was consistent with reopening of a small residual fistula. Posttreatment MR angiography demonstrated transient reduction of flow in the nidus in two patients with intramedullary malformations treated with embolization. Permanent disappearance of flow in the perimedullary vessel was seen after endovascular treatment in two patients with perimedullary fistula.

CONCLUSION: MR angiography is more sensitive than MR imaging in depicting residual or recurrent flow in peri- or intramedullary vessels, which indicates patency of the vascular malformation.

Index terms: Arteriovenous malformations, spinal, 30.149 • Arteriovenous malformations, therapeutic embolization, 30.1264 • Magnetic resonance (MR), vascular studies, 30.121411, 30.12142, 30.12143 • Spinal cord, abnormalities, 30.149 • Spinal cord, blood supply, 30.149 • Spinal cord, MR, 30.121411, 30.12142, 30.12143

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