Question:

Which of the following statements are correct regarding vertebral arteriovenous fistulae?
1. Doppler ultrasound is a definitive investigation
2. Contrast enhanced MRA is the "gold-standard" investigation
3. Venous enhancement on MRA can obscure the point of fistulous connection
4. Use of CT angiography allows 3D multiplanar analysis
5. Vessel wall calcification can limit the accuracy of CT angiography





Answer:

The correct answers for the question "Which of the following statements are correct regarding vertebral arteriovenous fistulae?" are:

3. Venous enhancement on MRA can obscure the point of fistulous connection

4. Use of CT angiography allows 3D multiplanar analysis

5. Vessel wall calcification can limit the accuracy of CT angiography



Explanation

a) The diagnosis can be suggested by Doppler ultrasound, with arterial flow seen in dilated adjacent veins, but it is often not possible to identify the exact site of involvement and differentiation from other conditions such as vertebral artery stenosis or an arteriovenous malformation is difficult.

b) Despite increasing use of MRA and CTA in diagnosis, conventional catheter angiography is the imaging technique of choice. It provides good anatomical detail and information regarding haemodynamics that is needed for treatment planning.

c) MRA can exhibit poor temporal resolution and slow scan times can, by scan completion, result in contrast filling of veins. Venous enhancement makes identification of the point of transition from artery to vein difficult.

d) Use of 3D software packages now integrated within PACS systems also allows a detailed multiplanar analysis of the vasculature.

e) The practical disadvantage of CTA is the confounding effect of vessel wall calcifications on image interpretation as well as artefact caused by metal, (specifically bullet fragments), which may obscure vascular detail. Similarly, shoulder streak artifacts may limit the diagnostic information in some cases.



From the manuscript:
Delayed presentation of a vertebral arterio-venous fistula secondary to penetrating cervical trauma: endovascular management using coil embolisation - a case report
Radiology Case. 2009 Jun; 3(6):9-15


This article belongs to the Interventional section.




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From the manuscript

Delayed presentation of a vertebral arterio-venous fistula secondary to penetrating cervical trauma: endovascular management using coil embolisation - a case report

Free full text article: Delayed presentation of a vertebral arterio-venous fistula secondary to penetrating cervical trauma: endovascular management using coil embolisation - a case report

Abstract
Vertebro-vertebral arteriovenous fistulae occur infrequently. We report on such a case with delayed presentation following penetrating neck injury. This was successfully treated via coil embolisation. A 40-year-old woman presented with a subjective tinnitus that was abolished by turning her head to the right. She had sustained penetrating neck trauma 6 months earlier. Doppler Ultrasound and magnetic resonance angiogram confirmed the presence of a vertebral arterio-venous fistula. Using a trans-femoral arterial approach, the left vertebral artery was embolised by deployment of multiple coils. The patient had no return of symptoms at 3 months follow up. Radiological diagnosis and endovascular management of this condition is discussed.






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