E-147 Combining time resolved contrast enhanced MR angiography with volumetric high resolution T2-weighted imaging is a highly accurate, non-invasive method for localization of spinal dural av fistulas: a case series
Abstract
Objective To describe a non-invasive method for prospectively localizing Spinal Dural AV Fistulas (SDAVF) with contrast enhanced magnetic resonance imaging prior to spinal angiography and treatment,by combining Time Resolved Contrast Enhanced MR Angiography (TRCE-MRA) with Volumetric High Resolution T2-weighted Imaging (VHR-T2-I) sequences. Background The gold standard for the localization of SDAVF is spinal angiography. A complete spinalangiogram involves the sampling of all segmental arteries, which can be time consuming and carries therisks of contrast nephropathy and radiation exposure. A non-invasive method of prospectively localizing the SDAVF feeding segmental arteries would be highly beneficial, as it would allow focusing the spinalangiogram to only a few vessels, decreasing procedure time and mitigating these risks. TRCE-MRA has been utilized in the localization of SDAVFs in the past. This method, however, has been limited by the inherent tradeoff that exists between temporal and spatial resolution in MR imaging. Even on advanced3 Tesla systems, TRCE-MRA of the spine at frame rates higher than 1 per 2 seconds have poor signal tonoise and anatomical detail, making the identification of the small SDAVF feeding vessels a challenge.VHR-T2-I sequences have very high anatomical detail but cannot assess vessel flow. In this case series,we present a method that co-registers the temporal information from TRCE-MRA and the spatial information from VHR-T2-I to prospectively…
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