OBJECTIVE The aim of this study was to investigate the utility of a heavily T2-weighted volumetric MRI sequence (3D sampling perfection with application-optimized contrasts using different flip-angle evolutions [SPACE]) in the feeder localization of spinal dural arteriovenous fistula (SDAVF). METHODS Patients who were diagnosed with SDAVF and who had 3D SPACE source images available for review were identified from a retrospective review of medical records. A total of 16 patients were identified, and MR images were analyzed separately by 2 blinded observers. The accuracy of the observation and interobserver agreement were measured by Kendall's tau and kappa statistics. RESULTS The site of fistula was accurately predicted by Observers 1 and 2 in 81% and 88% of cases, respectively, which improved to 94% when the level was considered within 1 vertebral level. The observer agreement with gold-standard angiography and interobserver agreement were found to be highly significant (p < 0.0001). CONCLUSIONS The 3D SPACE MRI sequence is valuable in the precise detection of the site of SDAVF. It may help to tailor digital subtraction angiography and thereby reduce the radiation exposure, contrast load, and study time.
Keywords: CTA = CT angiography; DSA = digital subtraction angiography; FOV = field of view; MIP = minimal-intensity projection; MRA = MR angiography; SDAVF = spinal dural arteriovenous fistula; SPACE = sampling perfection with application-optimized contrasts using different flip-angle evolutions, T2W = T2-weighted; high-resolution volumetric sequence; localization; sampling perfection with application-optimized contrasts using different flip-angle evolutions (SPACE); spinal dural fistula; vascular disorders.