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AJNR - American Journal of Neuroradiology

Published ahead of print on September 20, 2007
doi: 10.3174/ajnr.A0639

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American Journal of Neuroradiology 28:1806-1810, October 2007
© 2007 American Society of Neuroradiology

SPINE

Time-Resolved Spinal MR Angiography: Initial Clinical Experience in the Evaluation of Spinal Arteriovenous Shunts

S. Ali^a, T.A. Cashen^a,b, T.J. Carroll^a,b, E. McComb^a, M. Muzaffar^a, A. Shaibani^a and M.T. Walker^a

^a Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Ill
^b Department of Biomedical Engineering, Northwestern University, Chicago, Ill

Please address correspondence to Saad Ali, 676 N St Clair, Suite 1400, Chicago, IL 60611; e-mail: saad-ali{at}northwestern.edu

BACKGROUND AND PURPOSE: Spinal arteriovenous shunts usually require digital subtraction angiography (DSA) for evaluation. We report a unique time-resolved spinal MR angiographic (TRSMRA) technique with a temporal resolution of 3–6 seconds and spatial resolution of approximately 1 mm³ that has the potential to noninvasively detect, localize, and follow-up these cases.

MATERIALS AND METHODS: Eleven patients with clinical presentation and/or MR findings suspicious for a spinal arteriovenous shunt were referred for TRSMRA. Patients subsequently underwent spinal DSA to confirm the presence or absence of a shunt or were followed clinically until an alternative diagnosis was found. TRSMRA was also used to predict the level of the shunt in the positive cases. In addition, 2 of these patients as well as a 12th patient referred to us posttreatment received a follow-up TRSMRA to assess treatment outcome.

RESULTS: Early venous shunting was identified by using TRSMRA in 6 cases. All 6 were confirmed to have an AV shunt on subsequent spinal DSA. The shunt level predicted by TRSMRA consistently correlated with DSA to within 1 vertebral level. In the 5 patients with a negative screening TRSMRA, DSA or clinical outcome confirmed the absence of an arteriovenous shunt in all of the cases. Posttreatment TRSMRA in 3 patients accurately assessed the success or failure of treatment.

CONCLUSION: Combining acceleration techniques to achieve high frame rate TRSMRA provides sufficient temporal and spatial resolution to identify, localize, and follow patients suspected of having a spinal arteriovenous shunt. Further study in a larger population is warranted to assess the accuracy of this technique.