PubMed · 5675381
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N R Rao, R H Heptinstall. 1968. Experimental hydronephrosis. A microangiographic study.. https://pubmed.ncbi.nlm.nih.gov/5675381/
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STUDY DESIGN: A case of spinal dural arteriovenous fistula arising from a branch of the internal iliac artery is reported. OBJECTIVE: To report a rare case of spinal dural arteriovenous fistula supplied by a lateral sacral artery and treated with endovascular therapy. SUMMARY OF BACKGROUND DATA: Spinal dural arteriovenous fistulas usually occur in the thoracic and lumbosacral regions and arise from the intercostal and lumbar arteries. Rarely, they may occur in the sacral region, as in the reported case. METHODS: A 60-year-old man presented with progressive lower extremity paresis and decreased sensation below the waist of 6 months duration, which had progressed to paraparesis. Diagnostic imaging included magnetic resonance imaging and spinal angiography. RESULTS: A sacral spinal dural arteriovenous fistula was diagnosed with spinal angiography, which showed the spinal dural arteriovenous fistula arising from the right lateral sacral artery branches at S2, and magnetic resonance imaging, which showed enlarged pial vessels along the surface of the spinal cord and central cord hyperintensity, with peripheral hypointensity on T2-weighted images. The patient was definitively treated with endovascular therapy using polyvinyl alcohol particles and Tornado coils. His symptoms almost completely resolved within 6 months of therapy. CONCLUSIONS: Although surgical ligation is the treatment of choice, endovascular therapy may be an effective treatment for patients with sacral region spinal dural arteriovenous fistula in cases of high surgical risk. Spinal angiography remains the definitive diagnostic examination for pinpointing the site of the dural arteriovenous fistula.
BACKGROUND: Phase-contrast x-ray imaging using an x-ray interferometer has great potential to reveal the structures inside soft tissues, because the sensitivity of this method to hydrogen, carbon, nitrogen, and oxygen is approximately 1000 times higher than that of the absorption-contrast x-ray method. Imaging of vessels is very important to understand the vascular distribution of organs and tumors, so the possibility of selective angiography based on phase contrast is examined with a physiological material composed of low-atomic-number elements. METHODS AND RESULTS: Phase-contrast x-ray imaging was performed with a synchrotron x-ray source. Differences in refractive index, ddelta, of physiological saline, lactated Ringer's solution, 5% glucose, artificial blood such as pyridoxylated hemoglobin-polyoxyethylene conjugate, and perfluorotributylamine were measured. Because the ddelta of physiological saline has highest contrast, it was used for the phase-contrast x-ray imaging of vessel, and this was compared with absorption-contrast x-ray images. Vessels >0.03 mm in diameter of excised liver from rats and a rabbit were revealed clearly in phase-contrast x-ray imaging, whereas the vessel could not be revealed at all by the absorption-contrast x-ray image. Absorption-contrast x-ray images with iodine microspheres depicted only portal veins >0.1 mm in diameter with nearly the same x-ray dose as the present phase-contrast x-ray imaging. CONCLUSIONS: Phase-contrast x-ray imaging explored clear depiction of the vessels using physiological saline with small doses of x-rays.
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