A simple score (AVFS) to identify spinal dural arteriovenous fistula before spinal digital subtraction angiography

Spinal dural arteriovenous fistula (SDAVF) is a rare disorder with the presenting of nonspecific clinical symptoms and signs at onset, which can be a challenge to diagnose promptly and leads to the overusing of spinal digital subtraction angiography (SpDSA) in clinical practice. The purpose of this study was to find specific characteristics of SDAVF by comparing the clinical and radiologic data between the SpDSA-identified patients with SDAVF and SpDSA-negative patients, who were suspected with spinal vascular diseases before admission.

From 2006 to 2011, patients presented to Huashan hospital with spinal symptoms and who received SpDSA were retrospectively analyzed. Comparisons of clinical and magnetic resonance imaging data were performed between SpDSA-identified SDAVF and SpDSA-negative patients. We derived a diagnostic criteria score and assessed likely clinical usefulness to predict the SDAVF using the score to stratify all patients with suspected.

Four independent predictors (age ≥50 years, length of intramedullary lesion ≥5 vertical segments, perimedullary dilated vessels, and subcervical lesion) tested out by multivariable logistic regression and receiver operating characteristic analysis were significantly associated with SDAVF. A 4-point score (AVFS) including those criteria predicted the SpDSA-identified SDAVF with an area under the curve of .91 (95% confidence interval [CI] .84-.97, P < .001). A threshold of AVFS of 3 or more predicted SDAVF with a sensitivity of 85% (95% CI 62%-96%) and a specificity of 97% (95% CI 86%-99%).

The AVFS score may be useful in routine clinical practice to identify high-risk individuals with SDAVF who need further confirmation with SpDSA.