PMC8769409_01
(A) Sagittal T2-weighted MR image of thoraco-lumbar spine revealed intramedurally high signal intensity of the spinal cord with perimedullary flow voids. (B and C) Axial T2-weighted MR images demonstrated enlarged ventrolateral extradural venous plexus in the spinal canal from T12 to L3 (arrows). (D) Axial CT showed bone defect in the compressed fractured T12 vertebral body (arrow). (E) Coronal fat-suppressed T2-weighted MR image revealed flow voids in the T12 vertebral body in the area consistent with bone defect. CT: computed tomography, MR: magnetic resonance.
nmccrj-8-229-g001.jpg
PMC8769409_01_nmccrj-8-229-g001.jpg
F1
Spinal T2-weighted magnetic resonance (MR) images of the thoracolumbar spine revealed an intramedullary hypersignal intensity area in the spinal cord with perimedullary flow voids (Fig. 1A). Axial T2-weighted MR images demonstrated an enlarged epidural venous plexus ventrolateral to the spinal cord from T12 to L3 (Figs. 1B and 1C). T12 vertebral body and a bony defect inside (Fig. 1D). These findings were consistent with those of the chronic phase of a compression fracture. Fat- suppressed T2-weighted MR images revealed flow voids in the bony defect (Fig. 1E).
Selective catheter spinal angiography showed an epidural AVFs fed by the left-sided segmental arteries from T11 to L1 (white arrows) and intradural reflux via the right L2 radiculomedullary vein (black arrow). (A) The spinal epidural AVF had only a single intradural drainer that connecting with perimedullary vein. These findings implied low-flow volume AV shunt (black arrowhead). (B and C) Axial and coronal spinal angiography also showed intraosseous AV fistula connecting to the basivertebral vein of T12 (arrows). AV: arteriovenous, AVFs: arteriovenous fistulae.
nmccrj-8-229-g002.jpg
PMC8769409_01_nmccrj-8-229-g002.jpg
F2
T11 to L1 (Fig. 2A). The AVFs drained into two pathways: one with intradural reflux via the right L2 radiculomedullary vein and the other into the basivertebral vein of T12 (Figs. 2B and 2C). These findings implied a spinal osseous epidural AVF with intradural reflux.
(A) Coronal CT angiography after the operation revealed the disappearance of the intradural reflux. (B) Sagittal T2-weighted MR image 4 months after the operation showed the attenuation of the high signal intensity in the spinal cord. Kyphotic change at compression fracture was stable. (C and D) Axial T2-weighted MR images revealed the shrinkage of venous pouch (arrow). CT: computed tomography, MR: magnetic resonance.
nmccrj-8-229-g003.jpg
PMC8769409_01_nmccrj-8-229-g003.jpg
F3
Postoperative CT angiography confirmed the disappearance of the dilated perimedullary veins (Fig. 3A). T12 vertebral body (Figs. 3C and 3D). The kyphotic deformity of the thoracolumbar junction is under close observation.