title: The accuracy and utility of contrast-enhanced MR angiography for localization of spinal dural arteriovenous fistulas: the Toronto experience.
abstract: OBJECTIVE
  The purpose of this study was to determine the accuracy and utility of contrast-enhanced MR angiography (CE-MRA) in spinal dural arteriovenous fistulas (SDAVF).
  
  
  METHODS
  A retrospective analysis from 1999-2012 identified 70 patients clinically suspected of harboring a SDAVF. Each patient underwent consecutive conventional MR-imaging, CE-MRA, and digital subtraction angiography (DSA). The presence or absence of serpentine flow voids, T2-weighted hyperintensity, and cord enhancement were evaluated, as well as location of the fistula as predicted by CE-MRA. DSA was used as the reference standard.
  
  
  RESULTS
  Of the 70 cases, 53 were determined to be a SDAVF, 10 cases were shown to be other forms of vascular malformation, and 7 were DSA-negative. On MRI, all reported cases of SDAVF showed serpentine flow voids (100 %). T2-weighted hyperintensity was seen in 48 of 50 cases (96 %), extending to the conus in 41 of 48 cases (85 %). Cord enhancement was seen in 38 of 41 cases (93 %). CE-MRA correctly localized the SDAVF in 43 of the 53 cases (81 %).
  
  
  CONCLUSIONS
  CE-MRA is a useful non-invasive examination for the detection and localization of SDAVF. CE-MRA facilitates but does not replace DSA as confirmation of location, fistula type, and arterial detail, which are required before treatment.
  
  
  CONCLUSIONS
  • CE-MRA correctly localized the site of the SDAVF in over 80 % of cases. • CE-MRA facilitates diagnostic DSA and expedites the diagnostic process. • CE-MRA does not replace diagnostic DSA in SDAVF cases as confirmative test. • CE-MRA provides better understanding of missed or mislocalized SDAVF cases.
authors.affiliation: Department of Neurosurgery AB71, University Medical Center Groningen, PO Box 30001, 9700 RB, Groningen, The Netherlands, arjenlindenholz@hotmail.com.
authors.forename: Arjen
authors.initials: A
authors.lastname: Lindenholz
authors.forename: Karel G
authors.initials: KG
authors.lastname: TerBrugge
authors.forename: J Marc C
authors.initials: JM
authors.lastname: van Dijk
authors.forename: Richard I
authors.initials: RI
authors.lastname: Farb
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D020785:Central Nervous System Vascular Malformations / Q000175:diagnosis*; D002648:Child; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007472:Iohexol; D018810:Magnetic Resonance Angiography / Q000379:methods* / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009864:Ontario; D015203:Reproducibility of Results; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D003287:Contrast Media; D007472:Iohexol