Related Experiment Video
Updated: May 22, 2026
Creating Radio-cephalic Arteriovenous Fistula in the Forearm with a Modified No-Touch Technique
Published on: April 1, 2022
Utility of MRI in spinal arteriovenous fistula
Shahed Toossi1, S Andrew Josephson, Steven W Hetts
1Departments of Neurology, University of California San Francisco, CA, USA.
Objective And Background:
Spinal arteriovenous fistula (SAVF) is a rare but treatable cause of myelopathy. The diagnostic accuracy of MRI for detecting SAVF is unknown. Our objective was to determine the sensitivity and specificity of MRI in the diagnosis SAVF and characterize its radiographic features.
Methods:
We conducted a retrospective case-control study of all SAVF treated at our institution from 1995 to 2010, including patients who presented with myelopathy, had MRIs available for review, and underwent either spinal angiogram or had another diagnosis confirming test. Two blinded board-certified radiologists reviewed a series of MRIs and listed the most likely diagnoses, radiologic findings, and recommended follow-up. Sensitivities and specificities of MRI compared to spinal angiogram were calculated. We additionally conducted a literature review of cases describing MRI findings in spinal dural and perimedullary arteriovenous fistula.
Results:
We identified 36 cases of SAVF (median age 56, 67% male) and 32 controls (median age 54, 44% male). MRI was sensitive in identifying SAVF as the primary diagnosis in 94% (radiologist A, 95% confidence interval [CI] 0.87-1.02) and 89% (radiologist B, 95% CI 0.79-0.99) of cases. The sensitivity of spinal cord T2 hyperintensity or flow voids was 100% and the specificity of T2 hyperintensity and flow voids was 97%.
Conclusions:
Among patients with myelopathy, spinal angiography is mandatory in the presence of both T2 hyperintensity and flow voids but may be unnecessary if both of these findings are absent.
Insights
Magnetic resonance imaging (MRI) is highly sensitive for diagnosing spinal arteriovenous fistulas (SAVF), a treatable cause of myelopathy. If MRI shows T2 hyperintensity and flow voids, angiography is recommended; otherwise, it may not be necessary.
Area of Science:
- Neurology
- Radiology
- Vascular Surgery
Background:
- Spinal arteriovenous fistula (SAVF) is a rare condition that can cause myelopathy.
- The diagnostic accuracy of MRI for SAVF has not been well-established.
- Accurate diagnosis is crucial for timely and effective treatment of SAVF.
Purpose of the Study:
- To determine the sensitivity and specificity of MRI in diagnosing SAVF.
- To characterize the radiographic features of SAVF on MRI.
- To evaluate the necessity of spinal angiography based on MRI findings.
Main Methods:
- Retrospective case-control study of SAVF patients (1995-2010).
- Two blinded radiologists reviewed MRIs, listing diagnoses and findings.
- MRI sensitivity and specificity were calculated against spinal angiography.
Main Results:
- MRI identified SAVF as the primary diagnosis in 89-94% of cases.
- Sensitivity for T2 hyperintensity or flow voids was 100%.
- Specificity for T2 hyperintensity and flow voids was 97%.
Conclusions:
- MRI is a sensitive tool for diagnosing SAVF.
- Spinal angiography is essential when MRI shows both T2 hyperintensity and flow voids.
- Angiography may be unnecessary if these MRI findings are absent.
Related Concept Videos
01:25Hemodialysis I: Introduction
01:24Magnetic Resonance Imaging
01:20Venous Thrombosis II: Clinical Manifestations and Diagnostic Studies
01:19Imaging Studies VII: Vascular Imaging