Introduction Regression or disappearance of MRI abnormalities is usually observed after treatment of spinal arterio-venous fistulae (sDAVF).

Aim of Study We aimed to assess the correlation between MRI changes with sDAVF exclusion and clinical outcome.

Methods Imaging data of patients treated with endovascular embolization for sDAVF between 2007 and 2023 were retrospectively analyzed. Spinal cord edema and perimedullary flow voids at baseline and 3 month follow-up were compared between patients with and without sDAVF stable exclusion and clinical improvement on the Aminoff and Logue scale.

Results Twenty-five patients were included in this study. At 3-month follow-up, a regression of spinal cord edema was significantly associated with sDAVF stable exclusion (p=0.038). The combination of edema and flow voids regression was significantly associated with higher odds of cured sDAVF (p<0.001) and clinical improvement (p<0.01). The latter association presented high sensitivity (100% (CI95%; 78.20% - 100%)) and negative predictive values value (100% (CI95%; 47.82% – 100%)) for the detection of cured sDAVF in comparison to DSA.

Conclusion Patients with both spinal cord edema and flow voids regression at 3 months were more likely to present with a stable exclusion of sDAVF and clinical improvement after endovascular embolization. Patients without MRI improvement should be referred to DSA to seek recurrence of sDAVF.