The accuracy of the TRICKS MRI in diagnosing and localizing a spinal Dural arteriovenous fistula: A Feasibility Study.

Abstract: Purpose Spinal Vascular Malformations (SVM) are a heterogenous group of vascular abnormalities. The gold standard for diagnosis of SVMs is the spinal digital subtraction angiography (DSA) which can be challenging sometimes because of the large number of segmental arteries that need to be catheterized and the limitations in term of contrast volume used and fluoroscopy time. We will be describing and comparing the use of the time-resolved imaging of contrast kinetics (TRICKS) sequence and the DSA in the diagnosis of spinal dural arteriovenous fistulas (SDAVFs) in our institution. Methods It is a retrospective cohort study of 27 patients who had a TRICKS MRI followed by a DSA for the diagnosis of their SDAVFs between November 2003 and November 2021. Results 19 (70.4%) patients were positive for a SDAVF on both TRICKS MRI and DSA. Out of those 19, 9 (47.4%) were in the exact location on both TRICKS MRI and DSA while 10 (52.6%) were in different locations. With respect to the 10 patients who had discrepancies in their SDAVF localization between the two modalities, 9 (90%) patients had a 1-level difference and 1 (10%) had a 2- level difference. Conclusion TRICKS MRI represents an accurate screening tool to be performed before a spinal DSA in order to guide the interventionalist to focus on the correct level plus / minus 2 levels, this extra noninvasive screening tool will decrease the risk of a kidney injury from an overuse of contrast and minimize the fluoroscopy/radiation overexposure.