Introduction Spinal vascular lesions are rare but potentially devastating conditions which present challenges for diagnosis and characterization with noninvasive imaging modalities. Conventional spinal angiography is useful and sensitive in evaluating angioarchitecture but has limitations. The precise localization and understanding of angioarchitectural detail is essential for preoperative planning in endovascular or surgical management to reduce the risk of treatment failure or complications. The purpose of our study was to evaluate the use of three-dimensional (3D) rotational spinal angiography to enhance interpretation of conventional spinal angiography for a heterogenous collection of vascular pathological conditions.

Methods We performed a retrospective analysis of spinal angiograms at our institution between September 2020 and December 2022 to evaluate for spinal vascular lesions. This encompassed 34 patients with conventional angiography including 7 3D spinal angiograms which were obtained with apnea under general anesthesia. Multiple reconstructed images were obtained and evaluated by neuro-interventionalists at time of procedure and compared with conventional angiograms.

Results In a series of 34 patients (23 males, 11 females, mean age: 57 ± 17 years) with conventional spinal angiography, we identified six spinal arteriovenous malformations (AVMs), eleven spinal arteriovenous fistulas (spinal dural arteriovenous fistula [dAVF]: n = 10, spinal pial arteriovenous fistula [pAVF]: n = 1), four spinal tumors and thirteen with no vascular lesion. 7 3D spinal angiograms were acquired with four spinal arteriovenous malformations, two spinal arteriovenous fistulas and one with no vascular lesion. Three-dimensional reconstructed images were useful in delineating anatomy in relation to vasculature and surrounding bony structures. In particular, 3D angiography was helpful in determining anteroposterior relationships between vascular structures. No complications secondary to conventional or 3D rotational angiography were noted.

Conclusion The use of three-dimensional (3D) rotational spinal angiography for further characterization provided superior diagnostic information for localization of spinal vascular lesion compared to monoplane or biplane spinal angiography. 3D images were also helpful in obtaining better working angles for navigation and embolization. This snapshot study warrants further investigation to confirm these promising results.

Disclosures N. Krothapalli: None. S. Patel: None. E. Miller: None. C. Bruno: None. M. Ollenschleger: None. E. Sussman: None. T. Mehta: None.