Zusammenfassung
Ziel: Darstellung der klinischen und radiologischen Befunde der spinalen duralen arteriovenösen Fistelerkrankung (SDAVF) anhand von 54 diagnostizierten Fällen. Methoden: Auswertung der Krankengeschichten und der radiologischen Untersuchungsbefunde (23 Myelographien, 54 Magnetresonanztomographien, 54 Katheterangiographien) hinsichtlich Anamnese, klinischer Symptome und krankheitsspezifischer Befunde. Ergebnisse: Lange Anamnesedauer (Mittelwert 20 Monate) mit progredienten, aufsteigenden Paresen (100 %), Sensibilitätsstörungen (93 %) und Blasen-Mastdarmstörungen (89 %) bei männlichen Patienten (78 %) im fortgeschrittenen Lebensalter (Mittelwert 60 Jahre) weisen auf die Krankheit hin. Typische Befunde der MRT sind eine zentrale Signalanhebung des Myelons (100 %) mit lokaler Schwellung (74 %), Schrankenstörung (79 %) und erweiterten perimedullären Gefäßen (89 %), die myelographisch in 78 % der Fälle nachgewiesen wurden. Krankheitsbeweisend ist die Angiographie mit zumeist thorakaler Lokalisation der Fistel (69 %), mehr als einer fistelzuführenden Arterie (67 %) und venöser Drainage nach kaudal und rostral (63 %). Schlussfolgerungen: Die spinale MRT ist zum Nachweis der krankheitsrelevanten Befunde, die auf eine SDAVF hindeuten, sensitiver und spezifischer als die Myelographie und damit Untersuchungsmethode der ersten Wahl. Zur definitiven Krankheitsdiagnose ist die spinale Angiographie erforderlich.
Abstract
Purpose: Presentation of the clinical and radiological findings in spinal dural arteriovenous fistulas (SDAVF) based on the experience in 54 patients. Material and Methods: Evaluation of patients' records and myelography (n = 23), MRI (n = 54) as well as conventional angiography (n = 54) with respect to history, symptoms, clinical and radiological results. Results: Clinically, a long history (mean 20 months) with progressive ascending paresis (100 %), sensory deficits (93 %) and loss of control over bladder and bowel function (89 %) in male patients (78 %) of advanced age (mean 60 years) indicates the disease. Typical signs in MRI are central cord hyperintensity (100 %) with slight medullary distension (74 %), contrast enhancement (79 %) and distended perimedullary veins (89 %), the latter being disclosed by myelography in 78 % of cases. For diagnosis spinal angiography is necessary which most often shows a thoracic location of the fistula (69 %), more than one feeding artery (67 %) and caudal as well as rostral venous drainage (63 %). Conclusion: MRI is superior to myelography to detect diagnostic signs of SDAVF in patients with typical clinical presentation. For definitive diagnosis spinal angiography is still indispensable.
Key words
Vascular abnormalities - arteriovenous malformations - spinal dural fistula - spinal cord disease
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Dr. med. Christoph Koch
Abteilung Neuroradiologie, Universitätsklinikum Lübeck
Ratzeburger Allee 160
23538 Lübeck
Telefon: +49-451-500-4506
eMail: ckoch@medinf.mu-luebeck.de
