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British Journal of Radiology (2004) 77, 969-973
© 2004 British Institute of Radiology
doi: 10.1259/bjr/30760081
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Angiography-induced closure of perimedullary spinal arteriovenous fistula

K Aydin, MD1, S Sencer, MD1, A Sencer, MD2, E Terzibasioglu, MD1 and O Minareci, MD1

Departments of 1 Radiology and 2 Neurosurgery, Neuroradiology Division, Istanbul University, Istanbul Medical School, Capa, Istanbul, Turkey



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  		Figure 1. Spinal MR images. (a) Sagittal T2 weighted image of the thoracic spinal cord reveals enlarged, tortuous intradural veins. There is hyperintense signal intensity change in the lower thoracic cord (arrow). (b) Post-contrast sagittal T1 weighted image shows the pial enhancement in the lower thoracic regions and enlarged intradural veins.

 


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  		Figure 2. Angiography images of the selective injection of left thoracal 12th intercostal artery. (a) An early arterial phase image reveals the minimally enlarged posterolateral radiculomedullary artery (double arrows) feeding the fistula. The sudden change in the calibre of feeding artery demonstrates the point of the fistula (arrow). (b) Close-up image of another injection into left 12th intercostal artery shows the point of fistula (arrow) and also faint filling of the artery of Adamchiewicz from another radiculomedullary artery (open arrows). (c) Another angiography image demonstrates the artery of Adamchiewicz (white arrow) and arteriovenous fistula. (d) A late phase angiography image shows the filling of enlarged, tortuous intramedullary veins (white arrows).

 


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  		Figure 3. Follow up angiography. Selective injection of thoracal 12th intercostal artery reveals the disappearance of the arteriovenous fistula (AVF). The radiculomedullary artery which was previously feeding the AVF was thrombosed (white arrow). Note the normal filling of anterior radiculomedullary artery (black arrows), which gives rise to the artery of Adamchiewicz (open arrows).

 


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  		Figure 4. Follow up MR images demonstrate the thrombosis of arteriovenous fistula (AVF). (a) Sagittal T1 weighted image of the thoracic cord shows the hyperintense and isointense (compared with the intensity of the cord) thrombi in the enlarged intradural veins. (b) Sagittal T2 weighted image reveals the thrombosis of the enlarged dilated intradural veins. Mixed signal intensity on T2 and T1 weighted imaging is likely to be due to a mixture of breakdown products of haemoglobin within thrombus.

 




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