Spinal cord vascular disease: Characterization with fast three-dimensionalcontrast-enhanced MR angiography

BACKGROUND AND PURPOSE: Noninvasive characterization of spinal vascular les ions is essential for guiding clinical management, and several MR angiograp hic techniques have been applied in the past with variable results. The pur pose of our study was to assess the potential of a dynamic 3D contrast-enha nced MR angiographic sequence to characterize spinal vascular lesions and t o identify their arterial feeders and venous drainage. METHODS: A contrast-enhanced gradient-echo 3D pulse sequence providing angi ographic information within 24 seconds was applied prospectively in 12 cons ecutive patients with a presumed spinal vascular lesion. The images were ev aluated for visibility of the arterial feeder, and the results were compare d with those of conventional angiography performed the next day. RESULTS: The MR angiographic findings proved that the lesions were correctl y characterized as spinal arteriovenous malformations (AVMs) (n = 6), spina l dural arteriovenous fistulas (AVFs) (n = 3), a hemangioblastoma (n = 1), a teratoma (n = 1), and a vertebral hemangioma (n = 1), The arterial feeder was visible in all six AVMs and in the hemangioblastoma, corresponding to conventional angiographic findings. In two of three spinal dural AVFs, an e nlarged draining medullary vein was seen within the neural foramen, providi ng correct localization. The third fistula could not be seen owing to reduc ed image quality from motion artifacts. CONCLUSION: Fast 3D contrast-enhanced MR angiography is a noninvasive techn ique with high accuracy in the characterization of spinal vascular disease. Visibility of the arterial pedicles corresponds well with that of digital subtraction angiography, facilitating the management of these patients.