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Chronological changes in MRI findings of spinal dural arteriovenous fistula
T Horikoshi1, K Hida, Y Iwasaki
1Department of Neurosurgery, Hokkaido University School of Medicine, Japan.
Background:
Intramedullary high-intensity changes on T2-weighted magnetic resonance images (MRI) occur in patients with spinal dural arteriovenous fistulas (AVF). Reduction of the high-intensity area after treatment has been noted; however, there are still questions about whether the change is related to preoperative clinical grade, postoperative improvement, or efficacy of treatment. This study tried to clarify the relationship between chronological changes in the high intensity area with the treatment and clinical course.
Methods:
Chronological changes in an intramedullary high-intensity area after surgery were retrospectively analyzed in recent 13 patients with spinal dural AVFs who were treated and followed by MRI.
Results:
Preoperative intramedullary high-intensity areas were observed on T2-weighted images in all cases. The extent of the high-intensity area correlated with preoperative neurological deficits. The intramedullary high-intensity area was reduced or diminished after successful interruption of AVFs. The high-intensity area started to decrease within 1 to 4 months after treatment in all patients, and disappeared at 2 weeks to 23 months in seven patients. The reduction may suggest interruption of the fistula and improvement of venous circulation, but was not always correlated to clinical improvement. The intramedullary high-intensity areas rapidly disappeared in two patients, but did not clearly correspond to the clinical improvement.
Conclusions:
The time course of postoperative MRI changes is helpful for evaluating the efficacy of treatment after surgery for spinal dural AVFs.
Insights
Postoperative MRI changes in intramedullary high-intensity areas help evaluate treatment efficacy for spinal dural arteriovenous fistulas (AVFs). Reduction of these areas after AVF interruption indicates treatment success, though not always correlating with clinical improvement.
Area of Science:
- Neurosurgery
- Neuroradiology
- Vascular Neurology
Background:
- Intramedullary high-intensity changes on T2-weighted MRI are observed in spinal dural arteriovenous fistulas (AVFs).
- The relationship between these MRI changes, clinical grade, and treatment outcomes requires clarification.
- This study investigates the chronological changes in high-intensity areas post-treatment in relation to clinical course.
Purpose of the Study:
- To clarify the relationship between chronological changes in intramedullary high-intensity areas and the treatment and clinical course of spinal dural AVFs.
- To assess the utility of postoperative MRI findings in evaluating treatment efficacy.
Main Methods:
- Retrospective analysis of 13 patients with spinal dural AVFs.
- Evaluation of chronological changes in intramedullary high-intensity areas on T2-weighted MRI after surgical treatment.
- Correlation of MRI findings with preoperative neurological deficits and postoperative clinical outcomes.
Main Results:
- All patients presented with preoperative intramedullary high-intensity areas, correlating with neurological deficits.
- Successful AVF interruption led to reduction or disappearance of these high-intensity areas.
- High-intensity area reduction began within 1-4 months post-treatment, with complete resolution in seven patients between 2 weeks and 23 months; however, this did not always correlate with clinical improvement.
Conclusions:
- The time course of postoperative MRI changes is a valuable tool for assessing treatment efficacy in spinal dural AVFs.
- While reduction in high-intensity areas suggests successful AVF interruption and improved venous circulation, it is not a definitive predictor of clinical recovery.