• Feng Ouyang, Qin Wu, Meimei Yan, Jialu Chen, Zhijun Luo, Laisheng Pan, Bo Wang, Fuqing Zhou, and Xianjun Zeng.
• The First Affiliated Hospital of Nanchang University, Nanchang, China.
• Eur Spine J. 2025 Jan 9.

ObjectiveTo investigate the value of routine T2-weighted magnetic resonance imaging (MRI) and contrast-enhanced magnetic resonance angiography (CE-MRA) sequences in locating the fistula level of spinal arteriovenous fistula (SAVF).MethodsRetrospectively analyzed the radiological findings of patients with SAVF diagnosed by surgery from May 2018 to September 2024. All patients completed spinal CE-MRA and routine T2-weighted MRI. The imaging manifestations of SAVF lesions on CE-MRA and MRI were summarized and analyzed.ResultsWe enrolled 40 cases with SAVF (average age 58.1 years old, 85.0% male). The majority of fistulas were located in the thoracic (60.0%), followed by the lumbar (27.5%), and cervical (12.5%). Based on CE-MRA images, the fistula of 33 cases (82.5%) with SAVF can be accurately located, the perimedullary varicose vessels of 34 cases (89.47%) can be shown, and the feeding arteries of 27 cases (71.05%) can be identified. Based on T2-weighted MRI, the perimedullary flow voids and T2 hyperintensity were seen in 36 (90.0%) of SAVF cases, the fistula level in 88.9% (32/36) of cases was located at one end of the flow voids within 1 vertebral level, and the flow voids of 72.2% (26/36) cases near the fistula to be more tension. There is no significant difference in the accuracy of routine T2-weighted MRI in locating the fistula level compared to CE-MRA and digital subtraction angiography (DSA).ConclusionBoth routine T2-weighted MRI and CE-MRA sequences are valuable in the detection of SAVF fistula, we can locate the fistula level by the clues of the perimedullary varicose vessels.© 2025. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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