目的：探讨硬脊膜动静脉瘘（spinal dural arterio-venous fistula，SDAVF）的临床和影像学特征，以期提高临床上对SDAVF 的认识。

方法：报道1 例SDAVF 患者的临床诊治经过，并邀请神经内科及影像科专家结合相关文献对SDAVF 的临床和影像学特征进行解读。

结果：1 例SDAVF 患者的临床表现为进行性加重的右下肢麻木、行走不稳，麻木自右足小趾沿右腿外侧向上扩展至肛周，并逐步伴有腰部疼痛、二便障碍。胸椎磁共振成像（magnetic resonance imaging，MRI）平扫＋增强扫描显示第9 胸椎以下呈中心分布的长条状T2 加权成像高信号影，增强可见脊髓周围强化小血管影；腰椎MRI 平扫＋增强扫描显示脊髓圆锥T2 加权成像信号增高。在全身麻醉下行SDAVF 切除术。术后1.5 年进行随访，患者症状明显改善。

结论：SDAVF 的临床表现混杂，多不具有特异性；老年人以慢性进行性脊髓病变症状为表现时，应考虑本病可能。脊髓MRI 对提示SDAVF 诊断具有重要作用，临床医师和影像科医师都应掌握本病的经典MRI 特征，尽早做出正确诊断。早期治疗能够改善预后，避免症状恶化至不可逆转。

Objective: To investigate the clinical and imaging characteristics of spinal dural arteriovenous fistula (SDAVF) and improve the understanding of SDAVF in the clinical practice.

Methods: The clinical diagnosis and treatment of a patient with SDAVF were reported. Neurology and imaging experts were invited to discuss the clinical and imaging characteristics of SDAVF based on literature reviews.

Results: A SDAVF patient manifested progressive numbness of the right lower extremity and unstable working with numbness starting from the right little toe and propagating upwards along the outboard of the right leg to crissum. The patient developed low back pain and incontinence later. Thoracic spine magnetic resonance imaging (MRI) enhanced scan showed a long central strip with hyper-intensity on T2-weighted imaging below the ninth thoracic vertebrae, and small vascular shadows were enhanced around the spinal cord. Lumbar spine MRI showed the signal of T2-weighted imaging of the conus was increased. A surgical resection for SDAVF under general anesthesia was performed. One and a half years later after the surgery, the symptoms of the patient were alliviated a lot.

Conclusion: The clinical manifestation of SDAVF is mixed and usually atypical. However, SDAVF should be considered in the elders with slowly progressive myelopathic symptoms. Spinal MRI plays an important role in suggesting the diagnosis of SDAVF. Both clinicians and radiologists should be well aware of the classical MRI characteristics of SDAVF to make the correct diagnosis as soon as possible. Early treatment can improve the prognosis and prevent the symptoms from irreversibility.