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Spinal fistulas documented by contrast enhanced computed tomography during myelopathy workup: a lost opportunity

  • Spinal Neuroradiology
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Abstract

Purpose

Low-flow spinal arteriovenous fistulas (SAVFs) with intradural venous drainage typically manifest with a progressive venous hypertensive myelopathy (VHM) in older patients. VHM is difficult to identify. MRI is often nonspecific, and many cases are initially misdiagnosed, most often as transverse myelitis. The workup of myelopathic patients frequently includes thoracic and/or abdominal contrast-enhanced CT (CECT) that are generally not reviewed by neuroradiologists. The purpose of this work was to investigate how often abnormal enhancing intracanalar structures corresponding to the draining veins of a low-flow SAVF were documented by CECT.

Materials and methods

We evaluated 92 consecutive patients with low-flow SAVFs and VHM treated at our institution between 2009 and 2018. The study group included 22 of these patients with at least one thoracoabdominal CECT available for review. The control group consisted of 20 consecutive myelopathy patients with negative angiography and at least one thoracoabdominal CECT. Intracanalar enhancing structures were classified either as (i) conspicuous or (ii) equivocal or absent.

Results

One CECT in the study group was technically inadequate. Conspicuous intracanalar enhancing structures were observed in 20 of the remaining 21 patients with SAVFs (95.2%) and in 2 of 20 control patients (10%). None of the enhancing intracanalar structures was mentioned in official study reports.

Conclusions

The presence of enhancing vascular structures within the spinal canal on thoracoabdominal CECT obtained during the workup of myelopathies appears to represent a powerful but currently underappreciated tool for the detection of low-flow SAVFs.

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Funding

No funding was received for this study.

Author information

Authors and Affiliations

  1. Division of Interventional Neuroradiology and Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Abderrahmane Hedjoudje, Olwen C. Murphy, Lydia Gregg, Carlos A. Pardo & Philippe Gailloud

  2. Diagnostic and Interventional Radiology Department, Sion Hospital, Sion, Valais, Switzerland

    Abderrahmane Hedjoudje

  3. Baltimore, USA

    Abderrahmane Hedjoudje

Authors
  1. Abderrahmane Hedjoudje
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  2. Olwen C. Murphy
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  3. Lydia Gregg
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  4. Carlos A. Pardo
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  5. Philippe Gailloud
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Contributions

AH: Main author, data collection, image analysis, writing, images, study design

PG: Supervision, study design

LG: Illustrations

OM: Clinical data collection, database

CP: Clinical supervision, data collection

The author(s) declare(s) that they had full access to all of the data in this study and the author(s) take(s) complete responsibility for the integrity of the data and the accuracy of the data analysis.

Corresponding author

Correspondence to Abderrahmane Hedjoudje.

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Conflict of interest

PG consults for Cerenovus and has received research grants from Siemens Medical. The other authors declare no conflict of interest.

Ethical approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Hedjoudje, A., Murphy, O.C., Gregg, L. et al. Spinal fistulas documented by contrast enhanced computed tomography during myelopathy workup: a lost opportunity. Neuroradiology 63, 201–207 (2021). https://doi.org/10.1007/s00234-020-02601-x

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  • DOI: https://doi.org/10.1007/s00234-020-02601-x

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