PMC4492508_01
Sagittal T2-weighted (TR=3000 ms, TE=88 ms) images (A-D) of the spine demonstrate bulky lower dorsolumbar cord and conus medullaris with increased signal intensity and multiple intradural extramedullary areas of signal void. Grade 1 anterolisthesis of L4 over L5 vertebral body is noted.
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S1 level (Figure 1), more abundantly on the left side of Th10-Th12, causing rightward displacement of the lower part of the spinal cord.
Axial T1-weighted (TR=640 ms, TE=9.4 ms) noncontrast image at lower dorsal level (A) and following intravenous gadolinium administration, fat saturated, T1-weighted (TR=640 ms, TE=9.4 ms) axial (B), sagittal (C) and coronal (D) images demonstrate significant post-contrast enhancement of the lower cord and conus medullaris.
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Spinal cord exhibited intense, relatively homogenous enhancement after intravenous gadolinium injection (Figure 2). Subsequent spinal computed tomography angiography (CTA) was performed with a 16-slice scanner (Philips Brilliance 16, Philips Medical Systems) with nonionic iodinated contrast agent (Iohexol, 350 mg/mL) at dose of 2 mL/kg injected into the antecubital vein through pressure injector at a rate of 4 mL/sec with bolus tracking, with ROI placed over the abdominal aorta (scanning parameters: increment 1.0 mm, reconstruction interval 0.75 mm, slice thickness 2.0 mm, pitch 1.188, rotation time 0.75s, kVp 120, mA 200) CTA revealed an intradural extramedullary arteriovenous malformation (AVM) from Th10 to Th12 level (Figure 3) supplied by a branch of a great radicular artery (artery of Adamkiewicz).
Sagittal (A), coronal (B) and axial (C, D) spinal computed tomography angiography images, maximum-intensity projection showing intradural AVM with cord displacement.
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Spinal cord exhibited intense, relatively homogenous enhancement after intravenous gadolinium injection (Figure 2). Subsequent spinal computed tomography angiography (CTA) was performed with a 16-slice scanner (Philips Brilliance 16, Philips Medical Systems) with nonionic iodinated contrast agent (Iohexol, 350 mg/mL) at dose of 2 mL/kg injected into the antecubital vein through pressure injector at a rate of 4 mL/sec with bolus tracking, with ROI placed over the abdominal aorta (scanning parameters: increment 1.0 mm, reconstruction interval 0.75 mm, slice thickness 2.0 mm, pitch 1.188, rotation time 0.75s, kVp 120, mA 200) CTA revealed an intradural extramedullary arteriovenous malformation (AVM) from Th10 to Th12 level (Figure 3) supplied by a branch of a great radicular artery (artery of Adamkiewicz).
Sagittal curved planar reformat of (A) and volume rendered image of CTA (B) demonstrate the artery of Adamkiewicz feeding the AVM. Coronal curved reformat (C) showing drainage of the AVM through right 1st sacral foramen via an elongated tortuous vein.
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Th12-L1 intervertebral foramen (Figures 4-6). The
Digital subtraction angiography was performed by catheterizing the feeding artery. Lateral (A) and right anterior oblique (B) view in arterial phase show multiple dilated vessels within the spinal canal. Lateral views in the venous phase (C, D) show tortuous venous channels in the spinal canal. The lesion was embolized with 20% glue mixed with lipiodol (E). Post-procedure antero-posterior (F) and lateral (G) images show no opacification of the AVM.
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Th12-L1 intervertebral foramen (Figures 4-6). The
MR performed eight months after the procedure. Sagittal T1-weighted (A) and T2-weighted (B), as well as axial T2-weighted (C, D) images show thrombosed AVM (arrow in A) with irregular outline of the lower cord and conus, reduced bulk and altered signal suggesting gliotic changes.
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Th12-L1 intervertebral foramen (Figures 4-6). The