脊髓硬膜外动静脉瘘伴髓周静脉反流：一种被低估的血管疾病的临床和神经影像学特征。
Spinal Epidural Arteriovenous Fistula with Perimedullary Venous Reflux: Clinical and Neuroradiologic Features of an Underestimated Vascular Disorder.
机构信息
From the Departments of Diagnostic and Interventional Neuroradiology (M.M., A.O., F.J.)
From the Departments of Diagnostic and Interventional Neuroradiology (M.M., A.O., F.J.).
出版信息
AJNR Am J Neuroradiol. 2018 Nov;39(11):2095-2102. doi: 10.3174/ajnr.A5854. Epub 2018 Oct 18.
BACKGROUND AND PURPOSE
The purpose of this study was to discuss the clinical and radiologic characteristics of spinal epidural arteriovenous fistulas (SEAVF) and demonstrate their specific angiomorphology in a single-center series.
MATERIALS AND METHODS
Thirteen consecutive patients were diagnosed with SEAVF at RWTH Aachen University Hospital between 2006 and 2018 and were included in this study. All patients had MR imaging and DSA before treatment; 10 of these 13 patients received contrast-enhanced MRA (CE-MRA).
RESULTS
The mean patient age was 72 ± 8 years. Paraparesis was present in 12 (92%) patients. Sphincter dysfunction and sensory symptoms were observed in 7 (54%) and 6 (46%) patients, respectively. The mean duration of symptoms was 6 ± 8 months. Congestive myelopathy on MR imaging was present in all patients. Prominent arterialized perimedullary veins were demonstrated in only 3 cases. CE-MRA revealed arterialized perimedullary veins and an arterialized epidural pouch in 9/10 (90%) patients, mostly located ventrolaterally. DSA demonstrated a multisegmental extension of the arterialized ventrolateral epidural pouch in 6 (46%) cases. An intradural radicular drainage vein was localized distant from the original fistula point in 3 (23%) patients.
CONCLUSIONS
Congestive myelopathy with an acute/subacute clinical course was the dominant finding in spinal epidural arteriovenous fistulas. CE-MRA is a powerful diagnostic tool for identifying arterialized perimedullary veins as well as an arterialized epidural pouch. While arterialized perimedullary veins frequently present with only mild enlargement and elongation in spinal epidural arteriovenous fistulas, the arterialized epidural pouch is frequently located ventrolaterally and may extend over several vertebral levels. DSA remains the criterion standard to precisely visualize a spinal epidural arteriovenous fistula and its intradural radicular drainage vein, which may be located distant from the fistulous point.
背景与目的
本研究旨在讨论脊髓硬膜外动静脉瘘（SEAVF）的临床和影像学特征，并展示单中心系列中的特定血管形态学。
材料与方法
2006 年至 2018 年期间，在 RWTH 亚琛大学医院诊断出 13 例连续 SEAVF 患者，并将其纳入本研究。所有患者在治疗前均进行了 MRI 和 DSA 检查；其中 10 例患者进行了对比增强 MRA（CE-MRA）。
结果
患者平均年龄为 72±8 岁。12 例（92%）患者存在截瘫。7 例（54%）患者存在括约肌功能障碍，6 例（46%）患者存在感觉症状。症状的平均持续时间为 6±8 个月。所有患者的 MRI 均显示充血性脊髓病。仅 3 例显示突出的髓周动脉化静脉。9/10（90%）例患者的 CE-MRA 显示动脉化髓周静脉和动脉化硬膜外囊，主要位于腹外侧。6 例（46%）患者的 DSA 显示动脉化腹外侧硬膜外囊的多节段延伸。3 例（23%）患者的硬脊膜根引流静脉远离原始瘘口定位。
结论
充血性脊髓病伴急性/亚急性临床病程是脊髓硬膜外动静脉瘘的主要表现。CE-MRA 是识别动脉化髓周静脉和动脉化硬膜外囊的有力诊断工具。虽然在脊髓硬膜外动静脉瘘中，动脉化髓周静脉通常仅表现为轻度扩张和延长，但动脉化硬膜外囊通常位于腹外侧，并可能延伸至多个椎体水平。DSA 仍然是精确可视化脊髓硬膜外动静脉瘘及其硬脊膜根引流静脉的标准，后者可能远离瘘口定位。
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