Type 1 perimedullary arteriovenous fistula with subarachnoid hemorrhage: Utility of contrast-enhanced 3D gradient-echo technique

Abstract

Purpose: In patients with perimedullary arteriovenous fistula (AVF) with subarachnoid hemorrhage (SAH), knowledge of lesion location is necessary to select the appropriate approach for catheter spinal angiography. We evaluated the utility of 3-dimensional (3D) fast imaging with steady-state precession (FISP) sequence for detecting type 1 perimedullary AVF with SAH. Materials and Methods: We evaluated 4 patients (2 men, 2 women, aged 53 to 68 years, mean age, 59.25 years) with type 1 perimedullary AVF who presented with SAH and underwent conventional spin-echo MR and contrast-enhanced 3D FISP imaging. Two neu-roradiologists assessed detection of vascular lesions and delineation of their relationships to the adjacent vessels. Catheter angiography was used as the reference standard and compared with the MR findings. Results: Perimedullary AVF was located at the medullocervical junction in 2 patients, cervical spine in one, and thoracic spine in one. For all patients, use of contrast-enhanced 3D FISP in addition to conventional MR imaging improved lesion detection and delineation of the relationship between the lesion and surrounding vessels. Conclusion: Contrast-enhanced 3D FISP imaging was useful for detecting and delineating type 1 perimedullary AVF with SAH.