Investigating vascular myelopathy—when can magnetic resonance angiography replace digital subtraction angiography?

James V Byrne

This article has no abstract so we have provided the first paragraph of the full text.

The publication of the paper by Mull et al. is another step along a path that leads to the complete replacement of catheter-based angiography by noninvasive scanning methods for the diagnosis of spinal vascular malformations. The imaging of spinal cord arteries is a substantial challenge for MRA, and this paper presents some spectacular examples of the art. Historically, the imaging investigation of myelopathic patients with an AVM of the spine was considerably improved with the introduction of MRI, which can demonstrate intramedullary hemorrhage and the enlarged intradural vessels associated with spinal cord AVM. The diagnosis of DAVF is more difficult and is often only suspected on the basis of the finding of signal hyperintensity in the spinal cord (in the absence of swelling or contrast enhancement) caused by venous hypertension. The vessels that comprise the DAVF nidus are small, so DSA is currently needed in order to recognize the fistulous site. The question posed by this latest report is whether MRA, as an adjunct to conventional MRI, is adequate to dispense with spinal DSA (an invasive and time-consuming catheter-based method) for the diagnosis of DAVF and for preoperative assessment of all types of spinal cord AVM. The answer seems to be 'yes' if the MRA results (of the quality achieved by Mull et al.) are negative, and probably 'yes'—for treatment planning—when a spinal AVM or DAVF is found.

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