Phase contrast magnetic resonance of the spinal cord preliminary results in spinal cord arterio-venous malformations

Summary In spite of the recent advances in neuroradiology including the CT scan and the spin-echo-magnetic resonance (MR), accurate diagnosis of arteriovenous malformations (AVMs) involving the spinal cord is still based on selective angiography. This last procedure is invasive and needs to be repeated during the follow up. Phase contrast angio MR was performed with a 0.5 Tesla unit on 12 patients with an AVM involving the spinal cord (7 intramedullary AVMs, 4 perimedullary fistulas, and 1 dural fistula with perimedullary venous drainage); 4 of these were investigated before and after treatment. Angio MR showed abnormal vascular patterns within the spinal canal in all cases, without distinguishing between arteries and veins; the nidus of the intramedullary AVMs was displayed in all cases. Angio MR provided images of the whole AVMs comparable to the angiographic pictures, in contrast to the spin-echo MR, which provided only discontinued images of the vessels. The efficient range of velocity providing images varied, according to the type of the malformation (slow for dural fistulas, rapid for intra-medullary AVMs). In the 4 patients investigated after treatment, comparison of the images obtained before and after treatment permitted assessment of the degree of occlusion of the malformation. Finally, angio MR as a complement of spin-echo MR can now be used as a reliable tool for detection of spinal cord AVMs, assessing the indication for angiography, and, furthermore, it can probably replace most of the postoperative control angiographies. The value of the efficient imaging velocity is disputable but seems to depend on the haemodynamic characteristics of the malformation and may then serve as a guide to angiography.