Analysis of 30 Spinal Angiograms Falsely Reported as Normal in 18 Patients with Subsequently Documented Spinal...

Area of Science:

• Neuroradiology
• Interventional Radiology
• Vascular Neurology

Background:

• Early diagnosis of spinal vascular malformations is challenging due to nonspecific clinical and radiologic signs.
• Spinal angiography is crucial for diagnosis but requires a meticulous approach to maximize diagnostic yield.
• False-negative angiograms are concerning given the narrow therapeutic window for these conditions.

Purpose of the Study:

• To identify factors contributing to missed findings or inadequate diagnostic studies in spinal vascular malformations.
• To analyze causes of false-negative spinal angiograms in patients with confirmed vascular malformations.

Main Methods:

• Retrospective review of clinical records, laboratory findings, and imaging features of 18 patients with spinal arteriovenous fistulas and prior normal angiograms.
• Evaluation of patient clinical status using the Aminoff-Logue Disability Scale before and after treatment.

Main Results:

• Nineteen spinal vascular lesions in 18 patients were associated with 30 technically inadequate or false-negative spinal angiograms.
• Common causes included failure to identify angiographically documented lesions (55.6%), incomplete documentation of the region of interest (29.6%), and technically inadequate injections (14.8%).
• Treatment (endovascular or surgical) led to improved clinical scores in 76.5% of patients, often after a significant delay.

Conclusions:

• False-negative spinal angiograms are attributed to correctible, operator-dependent factors.
• Non-recognition of documented lesions is the primary cause of diagnostic errors.
• Implementing rigorous technical and training standards, along with second opinion reviews, can minimize false-negative study rates.