Korean J Radiol.  2011 Dec;12(6):740-744. 10.3348/kjr.2011.12.6.740.

Bilateral Carotid and Vertebral Rete Mirabile Presenting with a Prominent Anterior Spinal Artery Mimicking a Spinal Dural AV Fistula at MRI

• Lee SY
• Cha SH

• KMID: 1101929
• DOI: http://doi.org/10.3348/kjr.2011.12.6.740

Abstract

Bilateral carotid and vertebral rete mirabile (CVRM) is a very rare condition. We report a new case of CVRM initially detected by magnetic resonance imaging (MRI) of the cervical spine. MRI demonstrated tortuous vascular signal voids limited to the anterior cerebrospinal fluid space mimicking spinal dural arteriovenous fistula. A diagnosis of CVRM was confirmed on the basis of angiographic findings of rete formation associated with bilateral aplasia of the cavernous internal carotid and vertebral arteries without abnormal arteriovenous connection.

Keyword

Carotid and vertebral rete mirabile; MRI

MeSH Terms

Adult
Carotid Arteries/*abnormalities/pathology/radiography
Central Nervous System Vascular Malformations/*diagnosis
Cervical Vertebrae/pathology
Humans
*Magnetic Resonance Imaging
Male
Tomography, X-Ray Computed
Vertebral Artery/*abnormalities/pathology/radiography

Figure

• 

  Fig. 1 Bilateral carotid and vertebral rete mirabile in 28-year-old man. A. T2-weighted images of cervical spine MRI showing tortuous and dilated vascular signal voids (arrows) limited to anterior portion of spinal cord. B. Sagittal reconstructed maximum-intensity-projection image of CT angiography demonstrating dilated anterior spinal artery in spinal canal (black arrow) and fusiform dilatation of right distal vertebral artery (white arrow). C. Coronal reconstructed maximum-intensity-projection image and volume rendering image of CT angiography show hypoplastic cervical internal carotid artery and small carotid canal on right side (white open arrows) compared with normal cervical internal carotid artery and normal carotid canal on left side (black open arrows). D, E. Right common carotid artery angiography demonstrates diffuse narrowing of right internal carotid artery (thin arrows) and occlusion at level of cavernous internal carotid artery (thick arrow) accompanying transdural rete formation (open arrow) through external carotid artery branches. F. Left ICA angiography demonstrates segmental absence of cavernous ICA (white long arrow) with surrounding rete formation (open arrows). Distal basilar and posterior cerebral arteries (white short arrows) are being filled by posterior communicating artery (double arrowheads) and persistent trigeminal artery (arrowhead). All segments of left ICA except for cavernous segment and cerebral arteries appear normal. G, H. Left external carotid artery angiography demonstrates transdural rete formation (arrows) between internal maxillary artery and enlarged ophthalmic artery (arrowhead). I-L. Right (I, K, AP views; J, lateral view) and left vertebral artery angiography (L, AP view) show segmental agenesis at V3 segment (white arrow) with surrounding rete formation (black, open arrow). Saccular aneurysm (black arrowhead) at distal portion of rete and fusiform dilatation of V4 segment (black arrow) are demonstrated on right vertebral artery angiography. Enlarged radiculomedullary arteries (white arrowheads) are connected by dilated anterior spinal artery (double arrowheads) that is developed as collateral to asplastic segment. Right distal internal carotid and middle cerebral arteries supplied by posterior communicating artery (white, open arrows), appear normal.

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