Zalewski NL, et al. - Researchers investigated the efficacy of a gadolinium-enhanced magnetic resonance imaging pattern in distinguishing a spinal dural arteriovenous fistula from other causes of myelopathy. In this medical record review including 51 patients with a spinal dural arteriovenous fistula and pretreatment magnetic resonance imaging with gadolinium, 44 (86%) displayed intraparenchymal contrast enhancement, and 19 of these patients (43%) displayed the characteristic missing-piece sign. Patients with other myelopathy did not display the unique gadolinium enhancement pattern observed in sDAVF. Identification of missing-piece sign on magnetic resonance imaging may assist performing angiography early leading to improved outcomes for these patients.