Objective: Accurate diagnosis and demonstration of the angioarchitecture and localization of a spinal dural arteriovenous fistula is of crucial importance before treatment. Selective spinal angiography (DSA) has been considered the standard technique, but is invasive, time-consuming, and may be falsely negative. This report evaluates the use of noninvasive vascular imaging (computed tomographic and magnetic resonance angiography [MRA]) in patients suspected to have a dural fistula with spinal drainage.
Method: Ten consecutive patients had DSA and multidetector computed tomographic angiography (MDCTA), eight also had MRA. Nine were men with an average age of 67 years. In nine patients, the diagnosis was confirmed at surgery or intravascular treatment. Eight were proven to have a spinal dural fistula. In two, the fistula was within the cervical cranial dura. In all patients, the venous drainage involved only the spinal venous plexus.
Results: MDCTA identified the level of the feeding artery in nine patients. In two cases, selective DSA failed to show the abnormality found on MDCTA, but both were confirmed at surgery. MRA was diagnostic in a case in which the lesion was not accurately depicted by either MDCTA or DSA. MRA was less accurate than MDCTA in determining the level of the feeding artery.
Conclusion: MDCTA and MRA can direct and focus DSA. MDCTA gives additional useful three-dimensional bone detail and localization information for the surgeon. It may replace DSA if surgery is the planned treatment.