MR Angiography of the Spine and Spinal Cord

Research output: Contribution to journalReview article

42 Scopus citations


Objectives: This review has three objectives: 1) to describe spinal vascular anatomy, focusing on thoracolumbar intradural vessels detectable by both magnetic resonance angiography (MRA) and digital subtraction x-ray angiography (DSA), 2) to compare the MRA techniques that have been used to detect the major intradural vessels, and 3) to illustrate the clinical application of these MRA techniques, especially their efficacy in characterizing spinal dural arteriovenous fistulae (AVF). Methods: MRA is an adjunct to conventional magnetic resonance imaging. MRA is usually implemented as a three-dimensional (3D) contrast-enhanced (CE) gradient-echo technique, with two approaches to data acquisition: 1) "standard" 3D CE MRA, requiring ∼10 minutes per 3D volume, and 2) "fast" (bolus/dynamic) 3D CE MRA, requiring ∼0.5 to 2 minutes per 3D volume depending on k-space sampling schemes. Vessels are displayed on targeted maximum intensity projection images. Results: Normal intradural vessels detected on standard CE MRA are primarily veins (medullary and median), whereas both arteries and veins are detected on fast CE MRA. Identification of arteries (artery of Adamkiewicz, anterior spinal artery) is limited, and their differentiation from veins can be incomplete. Intradural vessels in patients with dural fistulae have abnormal features on MRI (length of flow voids and postcontrast serpentine enhancement) and standard 3D CE MRA (length, tortuosity, and qualitative size of dominant perimedullary vessel), which differ significantly from those of normal vessels. Standard MRA added to a conventional MRI study significantly (P = 0.016) increased the rate of detection of the spinal level of a dural fistula. The correct level ± one vertebral segment was identified in 73% of true-positive patients. Conclusions: Application of spinal MRA requires knowledge of vascular anatomy, specifically the major intradural vessels, and careful implementation of 3D CE MRA techniques. The standard technique allows for more effective noninvasive screening for vascular lesions, particularly dural AVF, than magnetic resonance imaging alone. Preliminary results indicate that the fast technique may further improve characterization of normal and abnormal intradural vessels, especially if continued technical advances yield greater temporal resolution while maintaining adequate spatial resolution.

Original languageEnglish (US)
Pages (from-to)444-460
Number of pages17
JournalTopics in Magnetic Resonance Imaging
Issue number6
StatePublished - Dec 1 2003


  • MR angiography (MRA)
  • MR imaging(MRI)
  • Spine
  • Vascular malformations
  • Vascular tumors
  • Vasulature

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

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