Skip to main content
Advertisement

Main menu

  • Home
  • Content
    • Current Issue
    • Accepted Manuscripts
    • Article Preview
    • Past Issue Archive
    • Video Articles
    • AJNR Case Collection
    • Case of the Week Archive
    • Case of the Month Archive
    • Classic Case Archive
  • Special Collections
    • AJNR Awards
    • Low-Field MRI
    • Alzheimer Disease
    • ASNR Foundation Special Collection
    • Photon-Counting CT
    • View All
  • Multimedia
    • AJNR Podcasts
    • AJNR SCANtastic
    • Trainee Corner
    • MRI Safety Corner
    • Imaging Protocols
  • For Authors
    • Submit a Manuscript
    • Submit a Video Article
    • Submit an eLetter to the Editor/Response
    • Manuscript Submission Guidelines
    • Statistical Tips
    • Fast Publishing of Accepted Manuscripts
    • Graphical Abstract Preparation
    • Imaging Protocol Submission
    • Author Policies
  • About Us
    • About AJNR
    • Editorial Board
    • Editorial Board Alumni
  • More
    • Become a Reviewer/Academy of Reviewers
    • Subscribers
    • Permissions
    • Alerts
    • Feedback
    • Advertisers
    • ASNR Home

User menu

  • Alerts
  • Log in

Search

  • Advanced search
American Journal of Neuroradiology
American Journal of Neuroradiology

American Journal of Neuroradiology

ASHNR American Society of Functional Neuroradiology ASHNR American Society of Pediatric Neuroradiology ASSR
  • Alerts
  • Log in

Advanced Search

  • Home
  • Content
    • Current Issue
    • Accepted Manuscripts
    • Article Preview
    • Past Issue Archive
    • Video Articles
    • AJNR Case Collection
    • Case of the Week Archive
    • Case of the Month Archive
    • Classic Case Archive
  • Special Collections
    • AJNR Awards
    • Low-Field MRI
    • Alzheimer Disease
    • ASNR Foundation Special Collection
    • Photon-Counting CT
    • View All
  • Multimedia
    • AJNR Podcasts
    • AJNR SCANtastic
    • Trainee Corner
    • MRI Safety Corner
    • Imaging Protocols
  • For Authors
    • Submit a Manuscript
    • Submit a Video Article
    • Submit an eLetter to the Editor/Response
    • Manuscript Submission Guidelines
    • Statistical Tips
    • Fast Publishing of Accepted Manuscripts
    • Graphical Abstract Preparation
    • Imaging Protocol Submission
    • Author Policies
  • About Us
    • About AJNR
    • Editorial Board
    • Editorial Board Alumni
  • More
    • Become a Reviewer/Academy of Reviewers
    • Subscribers
    • Permissions
    • Alerts
    • Feedback
    • Advertisers
    • ASNR Home
  • Follow AJNR on Twitter
  • Visit AJNR on Facebook
  • Follow AJNR on Instagram
  • Join AJNR on LinkedIn
  • RSS Feeds

AJNR Awards, New Junior Editors, and more. Read the latest AJNR updates

Review ArticleSpine Imaging and Spine Image-Guided Interventions
Open Access

Spinal Vascular Shunts: A Patterned Approach

M.P. Kona, K. Buch, J. Singh and S. Rohatgi
American Journal of Neuroradiology December 2021, 42 (12) 2110-2118; DOI: https://doi.org/10.3174/ajnr.A7312
M.P. Kona
aFrom the Division of Neuroradiology (M.P.K.), Department of Radiology, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for M.P. Kona
K. Buch
bDivision of Neuroradiology (K.B.), Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for K. Buch
J. Singh
cDivision of Neuroradiology (J.S., S.R.), Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for J. Singh
S. Rohatgi
cDivision of Neuroradiology (J.S., S.R.), Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for S. Rohatgi
  • Article
  • Figures & Data
  • Info & Metrics
  • Responses
  • References
  • PDF
Loading

Article Figures & Data

Figures

  • Tables
  • FIG 1.
    • Download figure
    • Open in new tab
    • Download powerpoint
    FIG 1.

    A, Normal arterial anatomy: 1, intramedullary branches; 2, sulcal artery; 3, anterior spinal artery; 4, radial perforators; 5, pial arterial plexus; 6, posterior spinal arteries; 7, segmental artery; 8, spinal artery; 9, dorsal branch of the dorsospinal artery; 10, ventral branch of dorsospinal artery; 11, ventral epidural plexus; 12, dorsal epidural plexus; 13, dural artery; 14, radicular artery; 15, ventral radicular artery; 16, dorsal radicular artery; 17, medullary artery. B, Normal venous anatomy: 1, Intramedullary veins; 2, sulcal vein; 3, radial veins; 4, pial venous plexus; 5, anterior spinal vein; 6, posterior spinal veins; 7, medullary vein; 8, ventral radicular vein; 9, dorsal radicular vein; 10, emissary vein; 11, intervertebral vein; 12, branches from ventral epidural venous plexus; 13, branches from dorsal epidural venous plexus.

  • FIG 2.
    • Download figure
    • Open in new tab
    • Download powerpoint
    FIG 2.

    A, Type I spinal dural AVF: 1, Intercostal artery; 2, spinal artery; 3, dorsal/muscular branch; 4, radicular artery, ventral branch; 5, radicular artery, dorsal branch; 6, radicular vein; 7, engorged perimedullary vein; 8, dural AVF. B, Type II spinal glomus AVM: 1, anterior spinal artery; 2, feeding arterial branch; 3, intramedullary glomus/nidus; 4, draining branch to pial venous network; 5, posterior spinal veins; 6, pial venous network. C, Type III spinal juvenile/metameric AVM: 1, normal cord tissue within the nidal interstices; 2, intramedullary elements of AVM; 3, extramedullary elements of AVM. D, Type IV IPAVF: 1, anterior spinal artery; 2, fistula; 3, multiple dilated perimedullary veins; 4, multiple contributing arterial feeders; 5, medullary artery; 6, ventral and dorsal radicular arteries.

  • FIG 3.
    • Download figure
    • Open in new tab
    • Download powerpoint
    FIG 3.

    A 79-year-old man with a type I spinal dural AVF. A, Sagittal T2 MR imaging of the thoracic spine shows extensive intramedullary edema as signal hyperintensity (white arrow) throughout the cord. The thin peripheral hypointense rim (yellow rectangle) may reflect deoxyhemoglobin within dilated peripheral capillaries. Serpiginous perimedullary flow voids (blue arrow) are most conspicuous along the dorsal aspect of the thoracic cord. B, Frontal view DSA injection of the left L3 segmental artery (white arrow) shows early filling of an ectatic spinal vein (black arrow).

  • FIG 4.
    • Download figure
    • Open in new tab
    • Download powerpoint
    FIG 4.

    A 45-year-old man with a type II spinal glomus AVM. A, Sagittal T2 MR imaging of the cervical spine shows serpiginous intramedullary and perimedullary flow voids (white arrow), with adjacent cord hyperintensity (blue arrow). B, Frontal view DSA injection of the right vertebral artery (red arrow) shows opacification of a feeding arterial branch (black arrow) and nidal elements (dashed outline). C, Lateral view DSA shows early filling of ectatic perimedullary veins (blue arrow).

  • FIG 5.
    • Download figure
    • Open in new tab
    • Download powerpoint
    FIG 5.

    A 14-year-old girl with a type III spinal juvenile/metameric AVM. A, Sagittal T2 MR imaging of the lumbar spine shows numerous ectatic perimedullary and intramedullary flow voids (blue/white arrow). B, Frontal view DSA injection of the right L2 lumbar artery shows opacification of a prominent anterior spinal artery (red arrow), intramedullary and extramedullary nidal elements (black arrow), and early filing of an ectatic perimedullary vein (blue arrow).

  • FIG 6.
    • Download figure
    • Open in new tab
    • Download powerpoint
    FIG 6.

    An 11-year-old boy with a type IV intradural-perimedullary spinal AVF. A, Sagittal T2 MR imaging of the thoracic spine shows enlarged, predominantly ventral, perimedullary flow voids (white arrow) indenting the ventral cord (yellow arrow). B and C, Sequential frontal view DSA images from injection of the left T9 segmental artery show contrast progression through the ASA (red arrow), nidus (black arrow), ectatic left radiculomedullary vein (blue arrow), left common iliac vein (green arrow), and inferior vena cava (white arrow). D, Frontal magnified DSA shows a catheter traversing the opacified ASA (red arrow) and embolization coil (black arrow) and Onyx (Covidien) (yellow arrow) material within the nidus. The draining vein no longer opacifies as a result of shunt obliteration.

  • FIG 7.
    • Download figure
    • Open in new tab
    • Download powerpoint
    FIG 7.

    A, A 41-year-old woman with normal CSF flow-related signal voids. Sagittal T2 MR imaging of the thoracic spine shows multiple prominent CSF flow voids (green arrows), mimicking the perimedullary vascular flow voids characteristic of spinal vascular shunts. B, A 71-year-old man with spinal stenosis. Sagittal T2 MR imaging of the lumbar spine shows multiple tortuous, redundant-appearing cauda equina nerve roots (yellow arrow) mimicking the perimedullary flow voids of a spinal vascular shunt above the levels of thecal sac stenoses (white and blue arrows).

  • FIG 8.
    • Download figure
    • Open in new tab
    • Download powerpoint
    FIG 8.

    A, A 61-year-old man with a cavernous malformation of the cervical cord. Sagittal T2 MR imaging of the cervical spine shows a small intramedullary mass with central hyperintense signal (white arrow) and a peripheral rim of low signal (black arrow), indicative of blood products in various stages of degradation. There is normal signal in the adjacent cord (yellow arrow). B, A 42-year-old woman with a history of Von Hippel-Lindau disease and cervical cord hemangioblastomas. Sagittal T2 MR imaging shows a small intramedullary mass (yellow arrow) with heterogeneous hyperintense internal signal and surrounding cord edema with cord expansion (blue arrow). C, Sagittal contrast-enhanced T1 with fat saturation depicts intense enhancement (white arrows) within multiple lesions.

Tables

  • Figures
    • View popup
    Table 1:

    Historical spinal vascular shunt classification schemes

    AuthorsYearClassification Summary
    Di Chiro et al51971Type I: Single coiled vessel (AVF)Type II: Glomus type (AVM)Type III: Juvenile (AVM)
    Heros et al61986Type IV: Direct AVF (IPAVF) involving the intrinsic arterial supply of the cord
    Gueguen et al719873 Types of classification of IPAVF (type IV) I) Single arterial feeder, small AVF II) Multiple feeders, medium AVF III) Multiple feeders, giant AVF
    Spetzler et al82002AVF types (and subtypes):ExtraduralIntradural (dorsal or ventral; and single (A) or multiple (B) feeders)AVM types (and subtypes):Extradural-intraduralIntradural (intramedullary, intramedullary-extramedullary, or conus medullaris)
    Zozulya et al92006Type I: IntramedullaryType II: Intradural or perimedullaryType III: DuralType IV: EpiduralType V: IntravertebralType VI: Combined
    Takai102017Proposed the addition of Type V: Extradural AVF, with subtypes Va/Vb: with/without intradural venous drainage
    • View popup
    Table 2:

    Imaging findings of spinal vascular shunts types I–IV

    Shunt TypeMRICTA/MRADSA
    I (SDAVF)T2 bright cord edema, ± thin T2 dark rim
    Cord expansion
    Prominent dorsal perimedullary flow voids
    May localize the involved dural artery along dorsal dural root sleeve
    Prominent draining medullary vein
    Definitive shunt localization
    Spinal arterial stasis in setting of cord edema
    II (SGAVM)Eccentric intramedullary flow voids of nidus on T2WI
    T2 bright cord edema
    Cord expansion
    ± Prominent perimedullary flow voids
    Heterogeneous nidal enhancement
    May depict multiplicity of arterial feeders
    Delineation of arterial feeders
    Aneurysms in one-third of cases
    ± Engorged perimedullary veins
    III (SJAVM)Extensive, ectatic flow voids may involve any tissues of a single metamere
    Normal cord tissue within nidal interstices
    ± Cord compression from large vascular structures
    Variable enhancement of the extensively involved vascular structuresNumerous ectatic high-flow intra- and extramedullary shunts
    Rapid antegrade drainage via intra-, or extramedullary venous structures
    IV (IPAVF)Prominent ventral perimedullary flow voids on T2 MR imaging
    ± Cord compression from perimedullary venous ectasia
    ± Cord edema/expansion on T2 MR imaging
    ≥1 arterial feeder and draining veins of variable size based on subtype
    ± Pia arachnoid enhancement
    Progressively increasing rates of flow with subtypes IVa–c
    May depict dilation of small pial surface arteries or venous aneurysms
PreviousNext
Back to top

In this issue

American Journal of Neuroradiology: 42 (12)
American Journal of Neuroradiology
Vol. 42, Issue 12
1 Dec 2021
  • Table of Contents
  • Index by author
  • Complete Issue (PDF)
Advertisement
Print
Download PDF
Email Article

Thank you for your interest in spreading the word on American Journal of Neuroradiology.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Spinal Vascular Shunts: A Patterned Approach
(Your Name) has sent you a message from American Journal of Neuroradiology
(Your Name) thought you would like to see the American Journal of Neuroradiology web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Cite this article
M.P. Kona, K. Buch, J. Singh, S. Rohatgi
Spinal Vascular Shunts: A Patterned Approach
American Journal of Neuroradiology Dec 2021, 42 (12) 2110-2118; DOI: 10.3174/ajnr.A7312

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
0 Responses
Respond to this article
Share
Bookmark this article
Spinal Vascular Shunts: A Patterned Approach
M.P. Kona, K. Buch, J. Singh, S. Rohatgi
American Journal of Neuroradiology Dec 2021, 42 (12) 2110-2118; DOI: 10.3174/ajnr.A7312
del.icio.us logo Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One
Purchase

Jump to section

  • Article
    • Abstract
    • ABBREVIATIONS:
    • CONCLUSIONS
    • Footnotes
    • References
  • Figures & Data
  • Info & Metrics
  • Responses
  • References
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • Application of Spinal Subtraction and Bone Background Fusion CTA in the Accurate Diagnosis and Evaluation of Spinal Vascular Malformations
  • Crossref
  • Google Scholar

This article has not yet been cited by articles in journals that are participating in Crossref Cited-by Linking.

More in this TOC Section

  • Optimization of Photon Counting CT Myelography
  • Characteristics of SIH Type I Culprit Lesions
  • Management Outcomes For VO Spine Biopsy
Show more Spine Imaging and Spine Image-Guided Interventions

Similar Articles

Advertisement

Indexed Content

  • Current Issue
  • Accepted Manuscripts
  • Article Preview
  • Past Issues
  • Editorials
  • Editor's Choice
  • Fellows' Journal Club
  • Letters to the Editor
  • Video Articles

Cases

  • Case Collection
  • Archive - Case of the Week
  • Archive - Case of the Month
  • Archive - Classic Case

More from AJNR

  • Trainee Corner
  • Imaging Protocols
  • MRI Safety Corner
  • Book Reviews

Multimedia

  • AJNR Podcasts
  • AJNR Scantastics

Resources

  • Turnaround Time
  • Submit a Manuscript
  • Submit a Video Article
  • Submit an eLetter to the Editor/Response
  • Manuscript Submission Guidelines
  • Statistical Tips
  • Fast Publishing of Accepted Manuscripts
  • Graphical Abstract Preparation
  • Imaging Protocol Submission
  • Evidence-Based Medicine Level Guide
  • Publishing Checklists
  • Author Policies
  • Become a Reviewer/Academy of Reviewers
  • News and Updates

About Us

  • About AJNR
  • Editorial Board
  • Editorial Board Alumni
  • Alerts
  • Permissions
  • Not an AJNR Subscriber? Join Now
  • Advertise with Us
  • Librarian Resources
  • Feedback
  • Terms and Conditions
  • AJNR Editorial Board Alumni

American Society of Neuroradiology

  • Not an ASNR Member? Join Now

© 2025 by the American Society of Neuroradiology All rights, including for text and data mining, AI training, and similar technologies, are reserved.
Print ISSN: 0195-6108 Online ISSN: 1936-959X

Powered by HighWire