Magnetic resonance angiographic localization of the artery of Adamkiewicz for spinal cord blood supply

Kawaharada, Nobuyoshi; Morishita, Kiyofumi; Hyodoh, Hideki; Fujisawa, Yasuaki; Fukada, Johji; Hachiro, Yoshikazu; Kurimoto, Yoshihiko; Abe, Tomio

doi:10.1016/j.athoracsur.2004.02.085

Cited by 60 publications

(49 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Kawaharada et al 17 were the first who related the clinical outcome in terms of paraplegia incidence to preoperative AKA localization. In this study of 86 patients, during surgery, only the segmental artery that supplied the AKA was reconstructed when it existed in the region of graft replacement.…”

Section: Mr Angiographymentioning

confidence: 99%

See 1 more Smart Citation

Advances in Spinal Cord MR Angiography

Backes

Nijenhuis²

2008

AJNR Am J Neuroradiol

View full text Add to dashboard Cite

SUMMARY:Novel developments in MR angiography are reviewed that enable non-invasive clinical imaging of normal and abnormal vessels of the spinal cord. Current fast contrast-enhanced MR techniques are able 1) to visualize vessels supplying or draining the spinal cord and 2) to differentiate spinal cord arteries from veins. The localization of the Adamkiewicz artery, the largest artery supplying the thoracolumbar spinal cord, has become possible in a reproducible and reliable manner. Knowledge of the anatomic location of this artery and its arterial supplier may be of benefit in the work-up for aortic aneurysm surgery to reduce incidences of ischemic injury. Spinal cord MR angiography is ready to become a diagnostic tool that can compete with catheter angiography for detecting and localizing arterial feeders of vascular lesions and is strongly advised for use prior to invasive catheter angiography. Successful clinical application strongly relies on in depth knowledge of the complex spinal cord vasculature and skills in image postprocessing. Due to their small calibers, clinical imaging of spinal cord arteries and veins was until recently only possible using catheter angiography. MR imaging by virtue of its strong soft tissue contrast is widely applied in patients suspected of harboring spinal vascular abnormalities. Using MR imaging in these patients, the diagnosis was predominantly based on changes of the cord tissue appearance but not on direct visualization of abnormal vessels.1 Even today it is beyond doubt that catheter angiography is the ultimate imaging technique for diagnosing, localizing, and classifying spinal vascular lesions.2 Despite its superior spatial resolution and image quality, it has, however, several major drawbacks, because it is invasive, involves exposure to ionizing radiation, and has a small risk for major complications.3,4 Furthermore, it is time consuming, may require a number of diagnostic sessions, and can only be performed by experts. Moreover, catheter angiography can be difficult to perform in patients with aortic diseases, such as aortic aneurysms.4,5 For these reasons, new developments in spinal cord angiography were prompted.It was mainly from clinical research in aortic aneurysm surgery that the request came to develop noninvasive visualization of normal arteries supplying the spinal cord to avoid the risk of paraplegia induced by interruption or damaging of the spinal cord blood supply. Catheter angiography is regarded as especially unattractive, because it is relatively hazardous in these patients due to the potential dislocation of aortic thrombi and because its sensitivity in detection of the main arterial supplier of the thoracolumbar spinal cord, that is, the Adamkiewicz artery (AKA), is too variable and too low (43%-86% 4-6 ). Traditional MR angiographic techniques before 2000 were not able to depict normal intradural arteries and were restricted to the visualization of pathologically dilated arteries and veins.7 Recent advances in MR and CT angiography were first demons...

show abstract

Section: Mr Angiographymentioning

confidence: 99%

“…[15][16][17] Here, noninvasive localization of the AKA is expected to contribute to the reduction of paraplegia incidences. Although catheter angiography carries only a small risk of severe complications (1.2% 4 ), this is significant compared with the currently achievable rates of paraplegia in aortic aneurysm surgery (3-5% 18 ).…”

Section: Relevancementioning

confidence: 99%

Advances in Spinal Cord MR Angiography

Backes

Nijenhuis²

2008

AJNR Am J Neuroradiol

View full text Add to dashboard Cite

show abstract

“…4,5,[10][11][12][13] The use of these imaging techniques for preoperative analysis and surgical planning enables selective reconstruction of the feeding radiculomedullary artery. 4,5,14 However, it is di‹cult to reconstruct the artery of Adamkiewicz itself because of its small size (about 0.5 mm in diameter) and its branching from the intercostal/lumbar artery at the intervertebral foramen. Therefore, in the surgical approach, 2 methods are used to maintain the blood ‰ow to the artery of Adamkiewicz.…”

Section: Discussionmentioning

confidence: 99%

MR Angiography for Detecting the Artery of Adamkiewicz and Its Branching Level from the Aorta

et al. 2009

Self Cite

View full text Add to dashboard Cite

Purpose: We evaluated the e‹cacy of magnetic resonance angiography (MRA) for detecting the artery of Adamkiewicz (AKA) and the vertebral level of its feeding arteries branching from the aorta.Materials and Methods: Eighty-two patients (67 men, 15 women; aged 34 to 86 years, mean age 68.6 years) with thoracic descending and thoracoabdominal aortic lesions (aneurysm in 55, dissection in 25, coarctation in 2) underwent MRA to detect AKA. MRA was performed using 6-phase, dynamic-enhanced, 3-dimensional, fast spoiled gradient recalled acquisition in steady state (GRASS) on a 1.5-tesla (T) system, with double-dose bolus contrast injection. The vertebral levels of AKA branching and the AKA feeder artery branching from the aorta were determined.Results: The AKA was detected in 67 patients (81.7z). Branching of AKA occurred at levels T7 to T12 on the left side (n＝52) and on the right (n＝15). Vascular continuity from the aorta to the anterior spinal artery was demonstrated in 55 patients (67.1z). Comparing the vertebral level of arterial branching from the aorta to that of the AKA at the intervertebral foramen, the AKA branched at the same vertebral level in 44 patients (80.0z), one vertebral level above/below in 10 (18.2z), and 2 vertebral levels above in one (1.8z).Conclusion: MRA can be useful in the preoperative work-up of patients with thoracoabdominal aortic lesions to localize AKA and the segmental trajectories of vessels supplying blood to the AKA.

show abstract

“…Spinal cord angiography was used to identify the main supply to the spinal cord (Kieffer et al, 2002). In another study, MRI was used for the detection of the Adamkiewicz artery (Kawaharada et al, 2004), and multidirectional row CT has also been used for the same purpose (Shiiya et al, 2009). The Adamkiewicz artery is the major blood supply to the lumbar spinal cord, and its reimplantation after TAA surgery reduced the risk of paralysis to 5-6%.…”

Section: Prevention Of Paralysis During Surgerymentioning

confidence: 99%