Detection of the common origin of the radiculomedullary artery with the feeder of spinal dural arteriovenous fistula using slab maximum intensity projection image

Abstract

Purpose

Endovascular therapy to the spinal dural arteriovenous fistula (SDAVF) with a common origin of the radiculomedullary artery and the feeder of the shunt has the risk of spinal cord infarction. This study aimed to retrospectively assess the detection rate of normal spinal arteries from the feeder of SDAVF.

Methods

We retrospectively collected the angiographic and clinical data of SDAVFs. This study included 19 patients with 20 SDAVF lesions admitted to our department between January 2007 and December 2018. We assessed the detection rate of normal radiculomedullary artery branched from the feeder of SDAVF between the period using the image intensifier (II) and flat panel detector (FPD) and evaluated the treatment results.

Results

The detection rates of the radiculomedullary artery branched from the feeder of SDAVF were 10% (1/10 lesions) during the II period and 30% (3/10 lesions) during the FPD period. During the FPD period, all normal radiculomedullary arteries branched from the feeder were only detected on slab maximum intensity projection (MIP) images of rotational angiography, and we could not detect them in 2D or 3D digital subtraction angiography. All lesions that had a common origin of a normal radiculomedullary artery and the feeder were completely obliterated without complications. There was no recurrence during the follow-up period.

Conclusions

The flat panel detector and slab MIP images seem to show the common origin of the normal radiculomedullary arteries from the feeder more accurately. With detailed analyses, SDAVF can be safety treated.

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Abbreviations

AKA:

Adamkiewicz’s artery

ARMedA:

anterior radiculomedullary artery

ASA:

anterior spinal artery

EVT:

endovascular therapy

FPD:

flat panel detector

II:

image intensifier

PRMedA:

posterior radiculomedullary artery

NBCA:

n-butyl-cyanoacrylate

PSA:

posterolateral spinal artery

SDAVF:

spinal dural arteriovenous fistula

2D-DSA:

two-dimensional DSA

3D-DSA:

three-dimensional DSA

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Acknowledgments

We thank Mr. Niida N (Siemens Healthcare) for his technical support with the reconstruction method of three-dimensional rotational angiography.

Funding

The authors have not received any research grant nor funding.

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Correspondence to Masafumi Hiramatsu.

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The study protocol was approved by the Ethics Review Board of our hospital.

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Hiramatsu, M., Sugiu, K., Yasuhara, T. et al. Detection of the common origin of the radiculomedullary artery with the feeder of spinal dural arteriovenous fistula using slab maximum intensity projection image. Neuroradiology (2020). https://doi.org/10.1007/s00234-020-02466-0

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Keywords

  • Slab MIP image
  • Spinal dural arteriovenous fistula
  • Radiculomedullary artery
  • Spinal artery