Endovascular therapy in DAVFs in 2 different patients (A−C and D−F, respectively). Endovascular therapy in DAVFs in 2 different patients (A−C and D−F,

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SPINAL DURAL ARTERIOVENOUS FISTULAE: MR IMAGING CHARACTERISTICS AND CLINICAL SIGNIFICANCE PATRICK DO, MD JEFFREY DORR, MD PRIYA KRISHNARAO, MD MAHESH PATEL,

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Color pressure maps (mm Hg) in a healthy subject in the axial (A) and coronal (D) planes as well as for a patient (C and F) with a type IIa DAVF affecting.

Lateral skull radiograph performed in our patient at age 4 years shows cystoperitoneal shunt connected to a VP shunt via a Y connector (dashed arrow, reservoir.

A and B, Sagittal (A) and axial (B) fast spin-echo images of the cervical spine before treatment demonstrate diffuse increase in signal intensity (arrows)

Patient with cholesteatoma on the right and chronic otitis media without cholesteatoma on the left. Patient with cholesteatoma on the right and chronic.

A, Sagittal T2WI MR image demonstrates a focal dorsal indentation (arrow) in the thoracic spinal cord. A, Sagittal T2WI MR image demonstrates a focal dorsal.

A, T2WI MR image demonstrates a focal dorsal indentation in the upper thoracic spinal cord (arrow). A, T2WI MR image demonstrates a focal dorsal indentation.

Right temporal AVM in a 28-year-old woman with seizures.

A, Postvertebroplasty CT scan demonstrates large cement leaks into the spinal canal, neural foramin (black arrow), and perispinus region. A, Postvertebroplasty.

Schematic overview of the Borden system of classification for DAVFs

Perimedullary SAVM in a 43-year-old female patient visualized by MR and catheter angiography: the problem of separating arteries from veins by MR angiography.

A 40-year-old man who presented with left-sided pulsatile tinnitus.

Right ECA angiogram in the lateral view shows the petrous branch of the MMA (black arrows) and the stylomastoid branch (white arrows) arising from the.

Evolution of imaging for internal auditory canal CPA cistern masses.

A, Coronal 3-mm-slab MIP from CTA in patient 3 with a right transverse sinus DAVF, predominantly supplied by right occipital, middle meningeal, and marginal.

The NeuroFlo catheter. The NeuroFlo catheter. A, Fluoroscopic images demonstrate the suprarenal (black arrow) and infrarenal (white arrow) balloons. B,

Coronal FLAIR images (A–C) document decreasing left hippocampal mass effect and signal intensity over 5-year period (black arrowhead). Coronal FLAIR images.

A, CT scan in a patient with metastasis involving the T7 vertebral body (asterisk). A, CT scan in a patient with metastasis involving the T7 vertebral.

AP (A) and lateral (B) radiographs demonstrating a discontinuous segment of the catheter, with broken catheter ends in the subcutaneous tissue of the lower.

A–C, Anteroposterior (A), oblique (B), and lateral (C) radiographs after thoracic interlaminar epidural injection of contrast material reveal opacification.

Following contrast enhancement, not only are the dilated perimedullary vessels depicted but sometimes (especially in the later stages of the disease) diffuse.

A 59-year-old woman (patient 5) with a right occipital parenchymal hemorrhage from a DAVF. A, CT scan demonstrates a right parenchymal hematoma. A 59-year-old.

Comparison of MR angiography with catheter angiography in a patient with a SDAVF. A, Sagittally oriented T2-weighted image displaying the signal intensity.

A, Initial fluoroscopic spot image (A) demonstrating disconnection at the pump connector (arrow). A, Initial fluoroscopic spot image (A) demonstrating.

Venous infarction in a patient with epidural and paraspinal abscesses.

A 52-year-old man presented with severe headache, slurred speech, and acute left hemiparesis. A 52-year-old man presented with severe headache, slurred.

Balloon angioplasty for treatment of atherosclerotic occlusion.

Osseous spinal epidural arteriovenous fistula in a 57-year-old man (case 9). Osseous spinal epidural arteriovenous fistula in a 57-year-old man (case 9).

Axial CT image through L5/S1 (3-mm section, 100 KVp, 50 mA).

Left transverse sigmoid DAVFs (type IIa) with 3 shunted venous pouches

Four more examples of missed additional aneurysms on DSA

Graph of neurologic scores (mean ± SD) for the moderate-severe VSPdelayed group, mild VSPdelayed group, and sham group. Graph of neurologic scores (mean.

Left ICA angiogram in anteroposterior (A) and lateral (B) views demonstrates the anastomosis between the mandibular artery arising from the petrous ICA.

A 19-year-old woman presented with acute onset of headaches to the emergency department. A 19-year-old woman presented with acute onset of headaches to.

When comparing a routine T2 TSE (A) sequence and a heavily T2-weighted (FIESTA, 3D T2 TSE, or CISS) sequence (B), the former depicts the cord edema better.

A and B, Sagittal T2-weighted sequence in case 4 demonstrates serpiginous flow voids along the ventral and dorsal spinal cord from the cervical region.

A, Axial 3-mm-slab MIP from CTA

Sagittal reconstruction of a CT scan of a 6-year-old boy (patient 3) after a fall (GCS = 15) demonstrates an REH (thick white arrow), which causes mild.

A 58-year-old man (patient 1) with a good-grade (Hunt and Hess II) subarachnoid hemorrhage from a torcular DAVF that was cured with a single Onyx injection.

62-year-old woman with incidentally discovered bilateral cavernous sinus aneurysms. 62-year-old woman with incidentally discovered bilateral cavernous.

Pretreatment DWI (A–C) and ADC maps (E–G) of a comatose 45-year-old man with areactive tetraplegia. Pretreatment DWI (A–C) and ADC maps (E–G) of a comatose.

External carotid angiogram, lateral view, with midarterial (A) and capillary (B) phase, shows the rich vascularity of the tumor. External carotid angiogram,

T2-weighted (A−C) and T1-weighted images following contrast enhancement (D−F) in 3 different patients demonstrate the spectrum of characteristic findings.

A 64-year-old man with a right descending thoracic vertebral artery.

A 32-year-old male patient with relapsing-remitting MS with several lesions, including 2 contrast-enhancing juxta-/intracortical lesions in the left frontal.

Multiplanar reformation of a 3D MR angiography image set of the spinal cord demonstrating the visualization of the AKA (arrow) and the ASA (arrowhead;

A, Right common carotid artery injection demonstrates massively enlarged inferolateral and meningohypophyseal trunks feeding a tentorial dural arteriovenous.

A, T1-weighted axial MR image shows a large metastasis (asterisk) involving the C2 vertebral body and extending into the surrounding soft tissues. A, T1-weighted.

Case 1. Case 1. Sagittal and axial T2-weighted images demonstrate the dilated venous recipient pouch for fistula 1 as well as dilated veins on the dorsal.

A, Anteroposterior (top row), lateral (second row), and axial (bottom row) projections of maximum-intensity 4D-CE-MRA images (2.9/1.4, 20° flip angle)

62-year-old woman (patient 5, Table 1) with sudden left-sided ptosis.

Giant infrasupraclinoid aneurysm of the right ICA

Falx cerebelli TDAVF (patient 1).

A 51-year-old man (patient 7) after 3 unsuccessful endovascular treatment attempts 10 years ago showing a progressive Borden I fistula on the right. A.

Case 1: Axial DWI through the maxillary sinus level demonstrates high signal intensity within the affected left maxillary sinus (black asterisk) compared.

Axial T2-weighted MR image shows normal flow void in the right internal jugular vein (arrows), whereas flow-related enhancement can be seen in the left.

A 78-year-old woman with severe right-sided hemiparesis and aphasia 70 minutes after symptom onset. A 78-year-old woman with severe right-sided hemiparesis.

Number of white streaks for the cobalt-containing alloy (upper, black lines) and titanium clips (lower, white lines) scanned in high mode (H) (open symbols,

ADC and astrocytoma grade.

Contrast-enhanced axial CT scan through the larynx with soft-tissue reconstruction demonstrates complete ossification of the thyroid (white arrow) and.

Illustrative patient 1.A, Anteroposterior (AP) view of the right dorsocervical artery obtained before embolization shows a large AVM involving C5-C7 and.

Case 23, a patient with treated DAVF with residual Borden type I shunt

Pseudoaneurysms demonstrated by femoral arteriography and sonography.

Acute (upper row) and chronic (after 6 months) effects following heroin inhalation (chasing the dragon). Acute (upper row) and chronic (after 6 months)

First-pass contrast-enhanced MRA can clearly demonstrate the early venous filling and thereby confirm the presence of a shunt in equivocal cases. First-pass.

In rare cases, the anterior spinal artery (black arrow) may arise from the same pedicle as the feeder to the shunt (shunting zone, asterisk; draining vein,

Imaging of a patient with HHT, for whom embolization was requested to treat recurrent epistaxis. Imaging of a patient with HHT, for whom embolization was.

A 42-year-old woman with a right parietal hematoma.

DSA of the left vertebral injection, lateral (A) and anteroposterior (B) views, and a coronal CTA image (C) from case 23 demonstrate a large unpaired thalamic.

Exemplary embolization procedure.

Presentation transcript:

Endovascular therapy in DAVFs in 2 different patients (A−C and D−F, respectively). Endovascular therapy in DAVFs in 2 different patients (A−C and D−F, respectively). A and D demonstrate the global injections verifying that no supply to the spinal cord is present from the pedicle from which the spinal DAVF is fed. The superselective injections demonstrated on B and E show the feeding artery (black arrow), the shunting zone (asterisk), and the proximal draining vein (white arrow). For an embolization to be effective, the glue has to penetrate from the artery via the shunting zone into the vein. C and F, Respective glue casts in both patients: While in the first patient (C) the glue cast did not reach the vein, in the second patient, the glue is visible within the proximal vein. The first patient will necessarily demonstrate recanalization with neurologic deterioration following a period of transient improvement of symptoms, due to the vast collaterals present in the dura, which will reconstitute the fistula. We would, therefore, strongly recommend early surgery (ie, in the same hospital setting). The patient seen in the lower row, though, is completely cured. T. Krings, and S. Geibprasert AJNR Am J Neuroradiol 2009;30:639-648 ©2009 by American Society of Neuroradiology