gms | German Medical Science

Objective: Efficient treatment management of spinal vascular malformation is facilitated by an excellent neuroradiological angiomorphological opacification. MRI, CE-MRA and DSA are the standard diagnostic tools in this disease. Recently, Dyna-CT imaging has been used to supplement existing imaging tools, and we report our own experience with Dyna-CT imaging in the context of various spinal malformations.

Methods: Fourteen patients were diagnosed in our center with spinal vascular malformations between 2015-2017 using a combination of MR imaging, DSA and Dyna-CT. 12 of these 14 patients underwent microsurgical treatment.

Results: Patient's age ranged between 24 and 86 years. A spinal dural arteriovenous fistula (SDAVF) was diagnosed in 8 patients: 4 (50%) thoracic, 3 (37,5%) lumbar and 1 (12,5%) sacral. Four other patients were diagnosed with an epidural arteriovenous fistula (SEAVF). The remaining 2 patients presented a medullary glomerular arteriovenous malformation (AVM).

In all cases Dyna-CT provided a precise identification of the feeding arteries, the drainage veins and the adjacent osseous structures of the AV-shunt. However, the intranidal hemodynamics of the two spinal AVM could be, betterevaluated by 2d DSA, compared with Dyna-CT. Intraoperative fluorescence imaging (ICG) in all 12 patients, who received microsurgical treatment, confirmed the Dyna-CT findings.

Conclusion: Dyna-CT images have a high contrast and isotropic spatial resolution, in comparison with 2d DSA, which allows an excellent opacification of the fistula zone, arterial feeders, venous drainage and adjacent osseous structures in the respective field of view. This all might be helpful for further interdisciplinary treatment management. In case of medullary vascular malformations, Dyna-CT provides a high contrast visualization of the nidus and its arterial and venous components. However, to evaluate the hemodynamic aspects of a spinal AVM, conventional 2d DSA remains the gold standard.