Chen C J, Chen C M, Lin T K
Department of Diagnostic Radiology, Chang Gung Memorial Hospital and University, Taipei, Taiwan.
Neuroradiology. 1998 Jun;40(6):393-7. doi: 10.1007/s002340050609.
Diagnosis of an intracranial dural arteriovenous fistula (DAVF) with spinal perimedullary venous drainage is challenging because the presenting symptoms are usually related to dysfunction of the spine, not of the brain. Repeated spinal angiograms are usually performed before the diagnosis is finally made by cerebral angiography. We report two cases of intracranial DAVFs with spinal perimedullary venous drainage. In both cases contrast-enhanced cervical MRI demonstrated dilated lower brainstem and upper spinal veins, which, we believe, is a good indicator of the existence of such drainage. We suggest that, in cases with perimedullary serpentine enhancement on thoracic or lumbar MR images, additional Gd-enhanced cervical spinal MR imaging should be performed. The simple process of tracing the veins upwards may avoid a lot of unnecessary examinations and delay in the diagnosis.
诊断伴有脊髓髓周静脉引流的颅内硬脑膜动静脉瘘（DAVF）具有挑战性，因为其出现的症状通常与脊柱功能障碍有关，而非大脑功能障碍。在最终通过脑血管造影确诊之前，通常会反复进行脊髓血管造影。我们报告了两例伴有脊髓髓周静脉引流的颅内DAVF病例。在这两例病例中，对比增强的颈椎MRI均显示脑干下部和脊髓上部静脉扩张，我们认为这是存在这种引流的良好指标。我们建议，对于胸段或腰段MR图像上出现髓周蛇形强化的病例，应额外进行钆增强的颈椎脊髓MR成像检查。简单的向上追踪静脉的过程可能会避免许多不必要的检查和诊断延误。
