AJNR. American journal of neuroradiology · 2026
Shunting Arterio-Venous Lesions of The Cervical Spine: Diagnosis Across Imaging Modalities.
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Isikbay Masis, Caton Michael Travis, Mattay Raghav, Walia Sartaaj, Cooke Daniel, Raper Daniel, Winkler Ethan, Savastano Luis, Narsinh Kazim, Hetts Steven, Amans Matthew
Аннотация
BACKGROUND: Shunting arteriovenous lesions of the central nervous system historically have been challenging to diagnose on non-invasive imaging given their subtle findings and complex anatomy. For this reason, catheter directed angiography has remained the gold standard for diagnosing and characterizing these lesions. While this should always remain a core component of working up suspected vascular lesions, other imaging modalities can be useful for making the diagnosis.
METHODS: We identified patients with shunting arteriovenous lesions of the cervical spine at our institution between the 1998-2023 and created a cohort of distinct vascular lesions. The imaging workup of each patient was reviewed to identify any diagnostic imaging modality which could detect a possible related abnormal finding. The associated medical record (including demographic data) was reviewed. Additionally, each patient's catheter directed angiography was evaluated to classify shunt location and presence of high-risk venous drainage.
RESULTS: 52 arteriovenous shunting lesions of the cervical spine were identified. In certain cases non-invasive diagnostic imaging modalities identified an abnormality prior to catheter directed angiography (32/52, 62%). The most common modality to identify a relevant finding was MRI/MRA, (22 out of 39 patients who received an MRI revealed a relevant finding, 79%) with the most frequent finding being a discrete vascular lesion seen on MRI/MRA (11/22 positive cases, 50%). Notably a large portion of patients had no evidence of a vascular lesion prior to obtaining catheter directed angiography (20/52, 38%).
CONCLUSION: While catheter directed angiography remains the best method of diagnosing and characterizing shunting vascular lesions of the spine, a large proportion of patients have imaging findings on non-invasive diagnostic imaging that suggest the presence of a vascular lesion. Identification of these imaging "clues", and subsequent referral to angiography, are essential to appropriate patient care given that many of these lesions have high risk features which can result in morbid complications.
METHODS: We identified patients with shunting arteriovenous lesions of the cervical spine at our institution between the 1998-2023 and created a cohort of distinct vascular lesions. The imaging workup of each patient was reviewed to identify any diagnostic imaging modality which could detect a possible related abnormal finding. The associated medical record (including demographic data) was reviewed. Additionally, each patient's catheter directed angiography was evaluated to classify shunt location and presence of high-risk venous drainage.
RESULTS: 52 arteriovenous shunting lesions of the cervical spine were identified. In certain cases non-invasive diagnostic imaging modalities identified an abnormality prior to catheter directed angiography (32/52, 62%). The most common modality to identify a relevant finding was MRI/MRA, (22 out of 39 patients who received an MRI revealed a relevant finding, 79%) with the most frequent finding being a discrete vascular lesion seen on MRI/MRA (11/22 positive cases, 50%). Notably a large portion of patients had no evidence of a vascular lesion prior to obtaining catheter directed angiography (20/52, 38%).
CONCLUSION: While catheter directed angiography remains the best method of diagnosing and characterizing shunting vascular lesions of the spine, a large proportion of patients have imaging findings on non-invasive diagnostic imaging that suggest the presence of a vascular lesion. Identification of these imaging "clues", and subsequent referral to angiography, are essential to appropriate patient care given that many of these lesions have high risk features which can result in morbid complications.