Yonsei Med J.  2015 Mar;56(2):397-402. 10.3349/ymj.2015.56.2.397.

The Use of Magnetic Resonance Imaging in Predicting the Clinical Outcome of Spinal Arteriovenous Fistula

• Shin DA
• Park KY
• Ji GY
• Yi S
• Ha Y
• Park SW
• Yoon DH
• Kim KN

• KMID: 2070016
• DOI: http://doi.org/10.3349/ymj.2015.56.2.397

Abstract

PURPOSE
Magnetic resonance imaging (MRI) has been used to screen and follow-up spinal dural arteriovenous fistulae (SDAVF). The purpose of this study was to evaluate the association between MRI findings and neurologic function in SDAVF. This study also investigated clinical features and treatment results of SDAVF.
MATERIALS AND METHODS
A total of 15 consecutive patients who underwent embolization or surgery for SDAVF were included. We treated seven (60%) patients with embolization and six (40%) with surgery. We analysed clinical features, MRI findings, treatment results, and neurologic function. Neurologic function was measured by the Aminoff-Logue disability scale (ALS).
RESULTS
Patients with longer levels of intramedullary high signal intensity in preoperative T2-weighted images (T2WI) exhibited worse pre- and postoperative ALS scores (r=0.557, p=0.031; r=0.530, p=0.042, Pearson correlation). Preoperative ALS score was significantly correlated with postoperative ALS score (r=0.908, p=0.000, Pearson correlation). The number of levels showing intramedullary high signal intensity in T2WI decreased significantly postoperatively (5.2+/-3.1 vs. 1.0+/-1.4, p=0.001, Wilcoxon ranked test).
CONCLUSION
The number of involved levels of high signal intensity in preoperative T2WI is useful for predicting pre- and postoperative neurologic function in SDAVF.

Keyword

Spine; dural arteriovenous fistula; magnetic resonance imaging; neurologic manifestations

MeSH Terms

Adult
Aged
Angiography
Arteriovenous Fistula/*pathology/radiography/*surgery
Central Nervous System Vascular Malformations/*pathology/radiography/*surgery
Embolization, Therapeutic/*methods
Female
Humans
*Magnetic Resonance Imaging
Male
Middle Aged
Postoperative Period
Predictive Value of Tests
Prognosis
Retrospective Studies
Severity of Illness Index
Spinal Cord/abnormalities/*blood supply/pathology/surgery
Treatment Outcome

Figure

• 

  Fig. 1 Illustrative case (Case 5). A 49-year-old male presented with progressive motor weakness for 18 months. (A) Preoperative T2-weighted MRI showed spinal cord oedema and venous engorgement. (B) Preoperative angiography. The fistula is located on the dorsal surface of the spinal cord, with a large arterialized vein emanating from the nerve root sleeve. (C) Postoperative MRI shows complete resolution of spinal cord oedema and venous engorgement. (D) Postoperative angiography. The proximal draining vein and fistula are embolized. Postoperative DSA image (anteroposterior view) demonstrating obliteration of the fistula.

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  Fig. 2 The number of involved levels showing high signal intensity in T2WI vs. pre- and postoperative Aminoff-Logue disability scale (ALS) scores. T2WI, T2-weighted images.

• 

  Fig. 3 Pre- and postoperative Aminoff-Logue disability scale (ALS) scores.

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