Imaging in Spinal Vascular Disease
Section snippets
Anatomy
To interpret MRI and DSA findings of spinal vascular diseases, it is necessary to be aware of the normal arterial supply and venous drainage of the spine and spinal cord. Segmental arteries supply the spine, including the vertebral bodies, paraspinal muscles, dura, nerve roots, and the spinal cord with blood. Radicular arteries are the first branches of the dorsal division of the segmental arteries. The bony spine is supplied by anterior and posterior central arteries that come directly from
Spinal cord ischemia
Compared with brain ischemia, spinal cord infarction is exceedingly rare and caused by more diverse etiologies [1]. This rarity is mainly caused by the multiple anastomoses of the spinal cord, which supply arteries. Spinal cord supplying arteries are—for unknown reasons—not significantly affected by atherosclerotic vessel wall changes. Causes for acute arterial ischemia include surgery for aortoiliac occlusive disease [6], dissection of the aorta, vasculitis, fibrocartilaginous embolism [7],
Spinal vascular malformations
Multiple different classification schemes have been proposed for spinal vascular malformations. Recently, the Bicetre group classified spinal cord arteriovenous malformations (AVMs) into three main groups [14]. The first group includes genetic hereditary lesions that are caused by a genetic disorder affecting the vascular germinal cells. Spinal cord malformations associated to hereditary hemorrhagic telangiectasia fall into this category. The second group includes genetic nonhereditary lesions
Dural arteriovenous fistulae
Spinal dural AV fistulae are the most frequent vascular malformations of the spine and account for 70% of all AV shunts of the spine [16]. They are presumably acquired lesions; however, the exact etiology is not known. Usually the disease becomes symptomatic in older men (aged 40–60 years) [17]. Most fistulae are located in the thoracolumbar region. The AV shunt is located inside the dura mater close to the spinal nerve root, where the arterial blood from a radiculomeningeal artery (ie, an
Spinal cord arteriovenous malformations
Spinal cord AVMs are fed by radicullomedullary (ie, spinal cord) feeding arteries and drained by spinal cord veins. These high-flow shunts might be intra- or perimedullarily located and can be differentiated according to their transition from artery into vein into fistulous and glomerular AVMs [30]. Glomerular AVMs (which are sometimes called plexiforme or nidus-type AVMs) are the most often encountered spinal cord AVMs, with a nidus resembling that of a brain AVM. This type of malformation
Cavernomas
Spinal cord cavernomas (or cavernous malformations) are estimated to constitute 5% of all spinal vascular malformations [46], [47]. Like their intracranial counterparts, cavernomas are discrete, lobulated, well-circumscribed, red to purple raspberry-like lesions on gross pathology. Microscopically, these lesions are composed of dilated, thin-walled capillaries that have a simple endothelial lining with variably thin fibrous adventitia indistinguishable from the lining of a capillary
Summary
The unspecific neurologic symptomatology and the variety of potentially detected vascular diseases make this clinical entity challenging for neurologists, neurosurgeons, and neuroradiologists. When spinal vascular diseases are suspected, MRI should constitute the first diagnostic modality to identify the lesion and rule out potential differential diagnoses (eg, acute cord compression, tumor, degenerative diseases of the spine, myelitis). Even with routine sequences, neuroradiologists should be
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