Evaluating Spinal Vessels and the Artery of Adamkiewicz Using 3-Dimensional Imaging

Accurate localization of the artery of Adamkiewicz (AKA) is important in planning treatment of patients with thoracoabdominal aortic disease. We assessed the usefulness of three-dimensional imaging devices such as multidetector- row helical computed tomography (MDCT) and 3 Tesla (T) MRI in the preoperative evaluation of the artery of Adamkiewicz (AKA) and its parent artery. Patients with thoracoabdominal vascular diseases underwent MDCT of the entire aorta and iliac arteries. Sub-millimeter collimation was used with the rapid injection of concentrated contrast material. The AKA and intercostal/lumbar arteries from which it originated were examined using multiplanar and curved planar reconstruction images and cine-mode display. The visualization of the AKA, as well as its branching level and site of origin, and the continuity of the intercostal/lumbar arteries with the AKA were investigated. 3T-MRA was also performed in patients whose AKA was difficult to visualize because of artifact from bony structures. In 90% of the patients the AKA was clearly visualized. The entire length from the trunk of the intercostal/lumbar arteries to the AKA, and finally to the anterior spinal artery could be traced using cine-mode display or on curved planar reconstruction images in 80%. These patients were treated by open surgical treatment based on a consideration of the vascular supply to the AKA or treated by stentgraft insertion. No postoperative ischemic spinal complications occurred in these patients except two. 3T-MRA increases success rate of visualizing AKA when used with MDCT. MDCT with Submillimeter collimation and a rapid injection protocol permits the evaluation of the AKA for its entire length and provides information on the intercostal and lumbar arteries and entire aorta. 3T-MRA has complementally role with MDCT.