• NaamaniKareem ElKEDepartment of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA., Rawad Abbas, Lisa Tartaglino, Ahmad Sweid, Nabeel A Herial, Stavropoula Tjoumakaris, Michael Reid Gooch, Robert H Rosenwasser, and Pascal Jabbour.
• Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
• World Neurosurg. 2022 Feb 1; 158: e592-e597.

ObjectiveSpinal vascular malformations (SVMs) are a heterogenous group of vascular abnormalities. The gold standard for diagnosis of SVMs is spinal digital subtraction angiography (DSA), which can be challenging because of the large number of segmental arteries that need to be catheterized and the limitations in term of contrast volume used and fluoroscopy time. We describe and compare the use of the time-resolved imaging of contrast kinetics (TRICKS) sequence and DSA in the diagnosis of spinal dural arteriovenous fistulas (SDAVFs) in our institution.MethodsThis is a retrospective cohort study of 27 patients who had a TRICKS MRI followed by a DSA for the diagnosis of their SDAVFs between November 2003 and November 2021.ResultsA total of 19 (70.4%) patients were positive for a SDAVF on both TRICKS MRI and DSA. Out of those 19, 9 (47.4%) were in the exact location on both TRICKS MRI and DSA whereas 10 (52.6%) were in different locations. With respect to the 10 patients who had discrepancies in their SDAVF localization between the 2 modalities, 9 (90%) patients had a 1-level difference and 1 (10%) had a 2-level difference.ConclusionsTRICKS MRI represents an accurate screening tool to be performed before a spinal DSA in order to guide the interventionalist to focus on the correct level ±2 levels; this extra noninvasive screening tool will decrease the risk of a kidney injury from an overuse of contrast and minimize the fluoroscopy/radiation overexposure.Copyright © 2021 Elsevier Inc. All rights reserved.

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