Spinal fistulas documented by contrast enhanced computed tomography during myelopathy workup: a lost opportunity.

Abderrahmane Hedjoudje, Olwen C Murphy, Lydia Gregg, Carlos A Pardo, Philippe Gailloud

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Article in Neuroradiology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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5 · Who and what money

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5 authors at 1 institution in 2 countries.

Abderrahmane HedjoudjeDivision of Interventional Neuroradiology and Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. a.hedjoudje@gmail.com.ORCID http://orcid.org/0000-0003-1081-9645

Olwen C MurphyDivision of Interventional Neuroradiology and Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Lydia GreggDivision of Interventional Neuroradiology and Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Carlos A PardoDivision of Interventional Neuroradiology and Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Philippe GailloudDivision of Interventional Neuroradiology and Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Johns Hopkins University · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeLow-flow spinal arteriovenous fistulas (SAVFs) with intradural venous drainage typically manifest with a progressive venous hypertensive myelopathy (VHM) in older patients. VHM is difficult to identify. MRI is often nonspecific, and many cases are initially misdiagnosed, most often as transverse myelitis. The workup of myelopathic patients frequently includes thoracic and/or abdominal contrast-enhanced CT (CECT) that are generally not reviewed by neuroradiologists. The purpose of this work was to investigate how often abnormal enhancing intracanalar structures corresponding to the draining veins of a low-flow SAVF were documented by CECT. MATERIALS AND

methodsWe evaluated 92 consecutive patients with low-flow SAVFs and VHM treated at our institution between 2009 and 2018. The study group included 22 of these patients with at least one thoracoabdominal CECT available for review. The control group consisted of 20 consecutive myelopathy patients with negative angiography and at least one thoracoabdominal CECT. Intracanalar enhancing structures were classified either as (i) conspicuous or (ii) equivocal or absent.

resultsOne CECT in the study group was technically inadequate. Conspicuous intracanalar enhancing structures were observed in 20 of the remaining 21 patients with SAVFs (95.2%) and in 2 of 20 control patients (10%). None of the enhancing intracanalar structures was mentioned in official study reports.

conclusionsThe presence of enhancing vascular structures within the spinal canal on thoracoabdominal CECT obtained during the workup of myelopathies appears to represent a powerful but currently underappreciated tool for the detection of low-flow SAVFs.

Indexed as

Arteriovenous FistulaSpinal Cord DiseasesAgedHumansMagnetic Resonance ImagingSpinal CordTomography, X-Ray ComputedVeinsCTMyelopathySpinal arteriovenous fistulas

Identifiers

PMID33196864

DOI10.1007/s00234-020-02601-x

OpenAlexW3102566637

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.