The accuracy and utility of contrast-enhanced MR angiography for localization of spinal dural arteriovenous fistulas: the Toronto experience

Eur Radiol. 2014 Nov;24(11):2885-94. doi: 10.1007/s00330-014-3307-6. Epub 2014 Jul 12.


Objectives: 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.

Key points: • 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.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Angiography, Digital Subtraction
  • Central Nervous System Vascular Malformations / diagnosis*
  • Child
  • Contrast Media
  • Diagnosis, Differential
  • Female
  • Humans
  • Iohexol*
  • Magnetic Resonance Angiography / methods*
  • Magnetic Resonance Angiography / statistics & numerical data*
  • Male
  • Middle Aged
  • Ontario
  • Reproducibility of Results
  • Retrospective Studies
  • Young Adult


  • Contrast Media
  • Iohexol