Clinical and Imaging Findings in Spinal Cord Arteriovenous Malformations

ABSTRACT

PURPOSE: To evaluate the findings of magnetic resonance (MR) imaging and selective spinal angiography of spinal cord arteriovenous malformations (SCAVMs) and to investigate the correlation of these findings with the development of clinical symptoms. MATERIALS AND METHODS: In 16 patients diagnosed as suffering from SCAVMs, MR imaging and selective spinal angiograms were retrospectively analyzed and correlated with clinical symptoms. Clinical data were reviewed, especially concerning the mode of onset of clinical symptoms, and MR images of SCAVMs were evaluated with regard to the following parameters spinal cord swelling with T2 hyperintensity, cord atrophy, intramedullary hemorrhage, and contrast enhancement of the spinal cord. Selective spinal angiographic findings of SCAVMs were also evaluated in terms of the following parameters type of SCAVM, presence of aneurysms, and patterns of venous drainage. Imaging findings were also correlated with the development of clinical symptoms. RESULTS: Neurologic deficits, either acute (n=4) or insidious (n=11), were noted in 15 patients. One case without any neurologic deficit was found incidentally. MR showed spinal cord swelling (10/6), atrophy (2/16), intramedullary hemorrhage (0/16), and contrast enhancement of the cord (8/12); spinal angiograms showed the presence of associated aneurysms (6/16) and radicular venous drainage (8/16). SCAVMs. were metameric (n=4), intramedullary (n=9), or fistular (n=3). Nine of 11 patients with insidious onset showed spinal cord swelling and no radicular venous drainage with prominent perimedullary venous dilatation. Aneurysms were present in all four patients with abrupt symptoms. CONCLUSION: Systematic evaluation of the findings of MR imaging and angiography provides detailed information on the type of AVM and status of the spinal cord parenchyma, and this can be correlated with clinical manifestations of SCAVM. In patients suffering from this condition, spinal cord dysfunction due to venous congestion appears to be the main cause of clinical symptoms.