|ECR 2019 / C-2783|
|Spinal arteriovenous lesions: anatomical and radiological approach|
Spinal arteriovenous (AV) lesions are a group of diverse and infrequent entities (5-10 cases / million), characterized by an abnormal communication between arteries and veins in the spine.
The understanding of their physiopathology has evolved gradually along years, resulting in different classifications and nomenclatures. One scheme divides spinal AV lessions according to their feeding artery in meningeal and pial lessions. This classification may be useful, however, we believe that it is difficult to apply in daily practice of neuroradiological diagnosis. Other nomenclature, based in physiopathology and anatomy aspects, divide spinal AV lessions in fistulas and malformations. We believe that this classification is easier to apply in neuroradiological practice.
These abnormal shunts leads to congestion and venous hypertension, hemorrhages, mechanical compression and vascular steal.
Spinal AV lesions, usually underdiagnosed, can manifest with a wide variety of neurological symptoms, so a high suspicion index is required.
The imaging findings depends on the technique to be used. MRI is the best non-invasive diagnostic method. It demonstrates flow voids along spinal cord in a peri/intramedullary situation, ussually associated with central T2 hyperintensity, swelling and sometimes some degree of Gadolinium enhancement of the spinal cord. The spinal cord atrophies over time. Conventional spinal angiography remains the gold standard to confirm the diagnosis, define precissely the vascular architecture of the lesion and planify the treatment.