title: First-Pass Contrast-Enhanced MRA for Pretherapeutic Diagnosis of Spinal Epidural Arteriovenous Fistulas with Intradural Venous Reflux.
abstract: Spinal epidural AVFs are rare spinal vascular malformations. When there is associated intradural venous reflux, they may mimic the more common spinal dural AVFs. Correct diagnosis and localization before conventional angiography is beneficial to facilitate treatment. We hypothesize that first-pass contrast-enhanced MRA can diagnose and localize spinal epidural AVFs with intradural venous reflux and distinguish them from other spinal AVFs.
  
  
  
  Forty-two consecutive patients with a clinical and/or radiologic suspicion of spinal AVF underwent MR imaging, first-pass contrast-enhanced MRA, and DSA at a single institute (2000-2015). MR imaging/MRA and DSA studies were reviewed by 2 independent blinded observers. DSA was used as the reference standard.
  
  
  
  On MRA, all 7 spinal epidural AVFs with intradural venous reflux were correctly diagnosed and localized with no interobserver disagreement. The key diagnostic feature was arterialized filling of an epidural venous pouch with a refluxing radicular vein arising from the arterialized epidural venous system.
  
  
  
  First-pass contrast-enhanced MRA is a reliable and useful technique for the initial diagnosis and localization of spinal epidural AVFs with intradural venous reflux and can distinguish these lesions from other spinal AVFs.
authors.affiliation: From the Division of Diagnostic and Interventional Neuroradiology, Department of Medical Imaging (S.M., T.J.H., P.M., W.M., A.B.), St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.|Division of Neuroradiology, Department of Medical Imaging (S.M., S.P.S., T.J.H.).
authors.forename: S
authors.identifier: 0000-0002-7334-3341
authors.initials: S
authors.lastname: Mathur
authors.affiliation: Division of Neuroradiology, Department of Medical Imaging (S.M., S.P.S., T.J.H.).|Department of Otolaryngology-Head and Neck Surgery (S.P.S.), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: S P
authors.identifier: 0000-0002-8025-9965
authors.initials: SP
authors.lastname: Symons
authors.affiliation: From the Division of Diagnostic and Interventional Neuroradiology, Department of Medical Imaging (S.M., T.J.H., P.M., W.M., A.B.), St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.|Division of Neuroradiology, Department of Medical Imaging (S.M., S.P.S., T.J.H.).
authors.forename: T J
authors.identifier: 0000-0001-9319-952X
authors.initials: TJ
authors.lastname: Huynh
authors.affiliation: From the Division of Diagnostic and Interventional Neuroradiology, Department of Medical Imaging (S.M., T.J.H., P.M., W.M., A.B.), St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: P
authors.identifier: 0000-0002-7062-9571
authors.initials: P
authors.lastname: Muthusami
authors.affiliation: From the Division of Diagnostic and Interventional Neuroradiology, Department of Medical Imaging (S.M., T.J.H., P.M., W.M., A.B.), St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: W
authors.identifier: 0000-0001-8282-1256
authors.initials: W
authors.lastname: Montanera
authors.affiliation: From the Division of Diagnostic and Interventional Neuroradiology, Department of Medical Imaging (S.M., T.J.H., P.M., W.M., A.B.), St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada BharathaA@smh.ca.
authors.forename: A
authors.identifier: 0000-0002-7923-7865
authors.initials: A
authors.lastname: Bharatha
mesh_terms: D000368:Aged; D015901:Angiography, Digital Subtraction / Q000379:methods; D020785:Central Nervous System Vascular Malformations / Q000000981:diagnostic imaging* / Q000473:pathology; D004824:Epidural Space / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D013116:Spinal Cord / Q000000981:diagnostic imaging* / Q000473:pathology