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Fig 6. Coronal digital subtraction angiography (DSA) projection (A) and multiplanar reformatted contrast-enhanced MR angiography (CE-MRA) of the early phase (B and C) and late phase (D) of a 43-year-old female patient (case 11) with a perimedullary arteriovenous malformation of the fistulous type (diagnosed on the basis of DSA). On the DSA projection image (A), the supplying segmental artery (SA) (asterisk), the great anterior radiculomedullary artery (ie, the Adamkiewicz artery [AKA]) (large white arrow), and the anterior spinal artery (ASA) (white arrowheads) are shown. The SA (asterisk) connecting to the AKA (large arrow) is falsely identified in the early phase CE-MRA (B) because of an erroneously created curved multiplanar reformation resulting from the many entangled vessels. Retrospectively, the correct SA (asterisk) supplying the AKA (large white arrows) was identified in the early-phase CE-MRA (C). The cephalad enhancement above the connection of the AKA (large white arrows) with the ASA is depicted only in the late phase CE-MRA image (D), and therefore is most likely to represent the anterior median vein (black arrowhead). In addition, there is enhancement of the venous plexus (small black arrows) in the late-phase CE-MRA image (D) that is not seen in the early phase CE-MRA image (B and C). Note the strong enhancement of the dilated and arterialized veins on the CE-MRA images, which is due to the nonselective manner of contrast administration. Furthermore, the AKA appears enlarged in the DSA as well as the CE-MRA examination.
