McRae-Posani Bala, Thakurdyal Ariana, Konner Marcus, Schreiber Craig, Edasery David, Knopman Jared, Gobin Y Pierre, Salama Gayle
Department of Radiology, Weill Cornell Medicine, New York-Presbyterian Hospital, USA.
State University of New York Upstate Medical University, USA.
Neuroradiol J. 2025 Jun 13:19714009251351292. doi: 10.1177/19714009251351292.
Engorgement of spinal intradural veins on MRI has classically been associated with spinal dural arteriovenous fistulas (sdAVF). We report a novel case of a patient who presented with worsening cognitive impairment, whose spinal MRI demonstrated marked intradural venous engorgement in the form of serpiginous perimedullary flow voids akin to sdAVF. Further investigation led to a diagnosis of CSF-venous fistula (CVF), a sub-type of spontaneous spinal CSF leaks without an associated extradural fluid collection. This is the first reported case of CVF mimicking sdAVF on MRI. While clinical presentations of CVF and sdAVF are typically distinct, there may be overlap and/or uncertainty in atypical presentations, such as in our patient. As such, the differential for spinal intradural venous engorgement should be expanded to include spontaneous CSF leaks, including CVF.
脊髓硬膜内静脉在磁共振成像（MRI）上的充血一直以来都与脊髓硬脊膜动静脉瘘（sdAVF）相关。我们报告了一例新病例，该患者出现认知功能障碍加重，其脊髓MRI显示硬膜内静脉明显充血，表现为类似于sdAVF的蜿蜒状髓周血流空洞。进一步检查诊断为脑脊液 - 静脉瘘（CVF），这是一种自发性脊髓脑脊液漏的亚型，且无相关硬膜外积液。这是首例在MRI上表现类似sdAVF的CVF病例报告。虽然CVF和sdAVF的临床表现通常不同，但在非典型表现中可能存在重叠和/或不确定性，就像我们的患者一样。因此，脊髓硬膜内静脉充血的鉴别诊断应扩大到包括自发性脑脊液漏，包括CVF。
