Gianna Blundo;
Virginia Commonwealth University School of Medicine
Yang Tang;
Virginia Commonwealth University School of Medicine
Background
Spinal vascular disease consists of a group of rare entities. It can present acutely due to cord ischemia/hemorrhage, or more insidiously, due to venous congestion/edema. The diagnosis is frequently made by MRI, although catheter spinal angiography remains reference standard in many cases to confirm the diagnosis and for treatment planning.
Educational Goals / Teaching Points
The purpose of this exhibit is to review the spinal vascular anatomy and various disease entities including cord infarction, arteriovenous fistula, arteriovenous malformation, cavernous malformation, and vascular tumor.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Vascular anatomy: The anterior and posterior spinal arteries are reinforced by radiculomedullary and radiculopial arteries that originate from segmental arteries at variable spinal levels. The dominant radiculomedullary artery feeding the thoracolumbar region is the great artery of Adamkiewicz, which typically arises between T8 to L3 on the left. Early spinal cord infarction may show diffusion restriction on DWI sequence. A variety of patterns on T2 sequence have been described, most commonly “owl’s eye” type of central cord involvement. Spinal vascular malformations can be classified into the following categories: • Type I: spinal dural AVF; • Type II: intramedullary AVM (glomus AVM with nidus); • Type III: intradural and extradural, metameric, or juvenile AVM; • Type IV: intradural perimedullary AVF. Cavernous malformation is angiographically occult but manifests as a well circumscribed lesion containing blood products of various ages on MRI. Hemangioblastoma is the most common vascular tumor of spinal cord and is associated with Von Hippel Lindau syndrome.
Conclusion
Spinal vascular disease is a rare but important differential consideration for patients with acute or chronic myelopathy. It is critical for radiologists to be familiar with the imaging appearance of these lesions.
