Fig 8.

Perimedullary SAVM in a 43-year-old female patient visualized by MR and catheter angiography: the problem of separating arteries from veins by MR angiography and of superimpositions in nonselective angiograms. A, Sagittal T2-weighted image showing increased signal intensity of the thoracolumbar cord and enlarged perimedullary and infraconal (serpentine) vessels raising the suspicion of a vascular spinal cord abnormality (small white arrows). B, Sagittal MIP of the MR angiography examination showing the overview and localization of the dilated vessels (small black arrows). C, In the coronal target MR angiography MIP, a mixture of enhanced tortuous arteries and veins is observed. D, On the catheter angiogram, the AP projection of the early phase shows filling of the largest SAVM-feeding radiculomedullary artery (white arrow), which derived from the first lumbar level (L1). In the late phase, the draining veins can clearly be distinguished from the artery (E), which was not possible with MR angiography (C). F, Due to the overprojection and the multiplanar reformation postprocessing, the origin of the large anterior radiculomedullary artery was first falsely localized at the 12th thoracic level (T12) on the MR angiogram (black arrow). G, Retrospectively, the correct level could be localized at L1 (black arrow). H, The T12 level gives rise to an additional posterior feeder of the SAVM, only localized by selective catheter angiography (gray arrow).⁴¹