Brinjikji W, Nasr D M, Morris J M, Rabinstein A A, Lanzino G
From Departments of Radiology (W.B., J.M.M.)
Neurology (D.M.N., A.A.R.).
AJNR Am J Neuroradiol. 2016 Feb;37(2):380-6. doi: 10.3174/ajnr.A4504. Epub 2015 Sep 3.
Spinal dural arteriovenous fistulas are commonly missed on imaging or misdiagnosed as inflammatory or neoplastic processes. We reviewed a consecutive series of spinal dural arteriovenous fistulas referred to our institution that were missed or misdiagnosed on initial imaging and studied the clinical consequences of missing or misdiagnosing the lesion.
We reviewed spinal dural arteriovenous fistulas diagnosed at our institution between January 1, 2000, and November 1, 2014. A lesion was defined as "misdiagnosed" if initial MR imaging or CT myelography demonstrated characteristic imaging features of spinal dural arteriovenous fistula but the patient was clinically or radiologically misdiagnosed. Outcomes included length of delay of diagnosis, increased disability (increase in mRS or Aminoff motor disability of ≥1 point) between initial imaging evaluation and diagnosis date, and posttreatment disability.
Fifty-three consecutive spinal dural arteriovenous fistulas that were initially misdiagnosed despite having characteristic imaging findings on MR imaging or CT myelography were included in our study. Eight patients (18.9%) underwent spinal angiography before referral, which was interpreted as having negative findings but was either incomplete (6 cases) or retrospectively demonstrated the spinal dural arteriovenous fistulas (2 cases). The median time of delayed diagnosis was 6 months (interquartile range, 2-14 months). Fifty-one patients (96.2%) had increased disability between the initial study, which demonstrated features of a spinal dural arteriovenous fistula, and diagnosis. Thirty-two patients (60.4%) developed a new requirement for a walker or wheelchair. Following treatment, 21 patients (41.2%) had an improvement of 1 point on the mRS or Aminoff motor disability scale.
Delayed diagnosis of spinal dural arteriovenous fistula with characteristic imaging features results in high rates of additional disability that are often irreversible despite surgical or endovascular treatment of the fistula.
脊髓硬脊膜动静脉瘘在影像学检查中常被漏诊或误诊为炎症或肿瘤性病变。我们回顾了一系列转诊至我院的脊髓硬脊膜动静脉瘘病例，这些病例在初次影像学检查时被漏诊或误诊，并研究了漏诊或误诊该病变的临床后果。
我们回顾了2000年1月1日至2014年11月1日期间在我院诊断的脊髓硬脊膜动静脉瘘病例。如果初次磁共振成像（MR成像）或CT脊髓造影显示出脊髓硬脊膜动静脉瘘的特征性影像学表现，但患者在临床或放射学上被误诊，则该病变被定义为“误诊”。观察指标包括诊断延迟时间、初次影像学评估与诊断日期之间残疾程度增加（改良Rankin量表[mRS]或阿明诺夫运动残疾评分增加≥1分）以及治疗后残疾情况。
本研究纳入了53例连续的脊髓硬脊膜动静脉瘘病例，尽管其在MR成像或CT脊髓造影上有特征性影像学表现，但最初仍被误诊。8例患者（18.9%）在转诊前接受了脊髓血管造影，结果被解读为阴性，但造影要么不完整（6例），要么回顾性显示存在脊髓硬脊膜动静脉瘘（2例）。诊断延迟的中位时间为6个月（四分位间距，2 - 14个月）。51例患者（96.2%）在初次检查显示脊髓硬脊膜动静脉瘘特征至诊断期间残疾程度增加。32例患者（60.4%）开始需要使用助行器或轮椅。治疗后，21例患者（41.2%）的mRS或阿明诺夫运动残疾量表评分改善了1分。
具有特征性影像学表现的脊髓硬脊膜动静脉瘘延迟诊断导致额外残疾发生率很高，尽管对瘘进行了手术或血管内治疗，这些残疾往往仍不可逆转。
