3D C-arm conebeam CT angiography as an adjunct in the precise anatomic characterization of spinal dural arteriovenous fistulas.
OBJECTIVE
Precise anatomic understanding of the vascular anatomy of SDAVFs is required before treatment. This study demonstrates the utility of C-arm conebeam CT to locate precisely the fistulous point in SDAVFs and the courses of their feeding arteries and draining veins.


METHODS
This retrospective study reports 14 consecutive patients with SDAVFs who underwent DSA and C-arm conebeam CT angiography. SDAVF sites included 5 thoracic, 7 lumbar, and 2 sacral fistulas. Selective DSA initially identified the location and arterial supply of the SDAVF. C-arm conebeam CT angiography was then performed with selective injection into the feeding artery. Reconstructed images were reviewed at a workstation with the referring surgeon, in conjunction with the standard 2D DSA images. The value of C-arm conebeam CT in depicting the fistula and the relationship to adjacent structures was qualitatively assessed.


RESULTS
In all 14 patients, C-arm conebeam CT angiography was technically successful and precisely demonstrated the site of the fistula, feeding arteries, draining veins, and the relationship of the fistula to adjacent osseous structures. Information obtained from the C-arm conebeam CT angiogram was considered useful in all surgically (12 patients) and endovascularly (2 patients) treated SDAVFs.


CONCLUSIONS
3D C-arm conebeam CT angiography is a useful adjunct to 2D DSA in the anatomic characterization of SDAVFs. The technique allowed improved visualization of the vascular anatomy of the SDAVFs and clearer definition of their spatial relationships to adjacent structures.
Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA.
T D
TD
Aadland
K R
KR
Thielen
T J
TJ
Kaufmann
J M
JM
Morris
G
G
Lanzino
D F
DF
Kallmes
B A
BA
Schueler
H
H
Cloft
D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D020785:Central Nervous System Vascular Malformations / Q000000981:diagnostic imaging*; D054893:Cone-Beam Computed Tomography / Q000379:methods*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012447:Sacrum; D013116:Spinal Cord / Q000098:blood supply* / Q000000981:diagnostic imaging*; D013904:Thoracic Vertebrae