title: The diagnosis of spinal dural arteriovenous fistulas.
abstract: METHODS
  Retrospective consecutive case series.
  
  
  OBJECTIVE
  To review and analyze clinical presentations and radiological imaging of 326 consecutive patients with spinal dural arteriovenous fistula (SDAVF) from 2 institutions.
  
  
  BACKGROUND
  The clinical presentations of SDAVF are nonspecific. Patients may be initially diagnosed with other spinal diseases. Magnetic resonance imaging (MRI) can reveal spinal cord changes associated with the disorder, but neurosurgeons often overlook these changes.
  
  
  METHODS
  From 1989 to 2009, 326 patients were diagnosed with SDAVF and treated at Qilu Hospital of Shandong University and the Xuanwu Hospital of the Capital University of Medical Sciences. We retrospectively reviewed the clinical records and radiological images of all patients, and collected and analyzed the related data.
  
  
  RESULTS
  Two hundred eighty-two males and 44 females (male/female ratio 6.4:1; mean age, 53.9 yr; SD, 12.1) were included in the study. Fistulas were located at the T7 spinal segment (41, 12.6%), but were more typically found at T5 to L5 (273, 82.5%). The most common initial symptoms were lower extremity weakness (234, 71.8%), sensory disturbance (229, 70.2%), and sphincter disturbance (87, 26.7%). These percentages increased to, 85.6%, 80.8%, and 52.5%, respectively, until patients were properly diagnosed. The mean diagnostic time to SDAVF was 19.9 months (SD, 25.2). Two major changes noted on magnetic resonance images were intramedullary T2-weighted signal hyperintensity (284, 87.1%) and perimedullary dilated vessels (251, 77%). Fistulas were often located outside of the vertebral segments of T2-weighted signal change (P = 0.005). Magnetic resonance angiography and computed tomography angiography of 33 (71.7%) patients revealed perimedullary dilated vessels and precisely located fistulas in 19 (41.3%) patients. Magnetic resonance angiography and computed tomography angiography studies of the perimedullary vessels also led to identification of a second fistula through angiography. Degenerative disc disease and myelitis were the most common misdiagnoses, and the patients were often treated incorrectly.
  
  
  CONCLUSIONS
  "Worsening" and "symptoms combination" are progression characteristics of SDAVF. Patients should undergo spinal magnetic resonance imaging when they are first suspected to have SDAVF. Magnetic resonance angiography and computed tomography angiography as noninvasive angiography are helpful for diagnosis.
authors: *Department of Neurosurgery, Qilu Hospital, Shandong University, Jinan, Shandong, P. R. China †Brain Science Research Institute, Shandong University, Jinan, Shandong, P. R. China; and ‡Department of Neurosurgery, Xuanwu Hospital of Capital University of Medical Sciences, Beijing, P. R. China.
authors: Wang
authors: W
authors: Donghai
authors: Yang
authors: Y
authors: Ning
authors: Zhang
authors: Z
authors: Peng
authors: Xu
authors: X
authors: Shuo
authors: Li
authors: L
authors: Xueen
authors: Zhao
authors: Z
authors: Peng
authors: Huang
authors: H
authors: Bin
authors: Li
authors: L
authors: Xingang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020785:Central Nervous System Vascular Malformations / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000592:standards; D008279:Magnetic Resonance Imaging / Q000592:standards; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D013116:Spinal Cord / Q000000981:diagnostic imaging / Q000473:pathology*; D013122:Spinal Diseases / Q000175:diagnosis* / Q000453:epidemiology; D055815:Young Adult