MR Angiography and CT Angiography of the Artery of Adamkiewicz: Noninvasive Preoperative Assessment of Thoracoabdominal Aortic Aneurysm

Abstract

It is important to identify the artery of Adamkiewicz in patients with thoracoabdominal aortic aneurysm to aid in surgical planning and to prevent postoperative paraplegia or paraparesis. However, the artery of Adamkiewicz is difficult to visualize and impossible or very dangerous to evaluate with selective intercostal or lumbar angiography. The feasibility, advantages, and limitations of magnetic resonance (MR) angiography and computed tomographic (CT) angiography in the preoperative assessment of the artery of Adamkiewicz were evaluated in 30 patients with thoracoabdominal aortic aneurysm. Initial results indicate that MR angiography and CT angiography are safe, effective, noninvasive procedures that allow clear visualization of the artery of Adamkiewicz by providing detailed depiction of the vascular anatomy from the aorta to the anterior spinal artery. However, further studies will be needed to assess the efficacy of these modalities in decreasing surgical risk.

Anatomia da circulação medular

“…The posterior radicular artery follows a anterior radicular artery anterior radicular a., 9,10,20 medullary a., 12 anterior medullary a., 18 anterior radiculomedullary aa., 16,17 a. radicular anterior, 19 anterior spinal canal a., segmental a. 21 Ramo radicular anterior (TA)…”

“…Posterior branch of the radicular artery posterior radicular a., 9,10,20 medullary a., 12 posterior medullary a., 18 posterior radiculomedullary aa., 16 a. radicular posterior, 19 posterior segmental medullary a. Anterior spinal artery a. spinalis anterior; 5,6 anterior spinal a., [12][13][14]18 anterior median spinal a., 10 anterior long spinal a. Artéria espinhal anterior (TA)…”

Spinal Cord- A Cadaveric Study

“…It is important to identify the location of AKA during surgical treatment of aortic aneurysm to prevent damage, which would result in insufficient blood supply to the spinal cord. 10 The arteria radicularis magna was also observed at T1 segment in 7.5% specimens (Table 2) on the left posterior aspect joining with posterior spinal artery. The same specimen shows arteria radicularis magna at T10 spinal segment (Figure 11).…”

“…The arteries descends separately in cervical region and at the lower end of the cervical enlargement fuse to form plexus on the posterior aspects of the cord. The posterior spinal arteries are found to be tortuous in its course ( Figure 9) unlike anterior spinal artery, which was straight in its course Figure (10). Single posterior spinal artery was also found in 2 specimens (5%).…”

Detection of the Adamkiewicz artery in computed tomography of the thorax and abdomen

“…In their study, aortic density was measured 3 times per s, and when the value reached a point of 130 HU, a helical CT began automatic scanning. 11 Boll et al used a similar system called automatic bolus tracking, with the peak of enhancement at 150 HU, after which scanning was automatically initiated. 10 When performing an examination that aims to detect the AKA -a vessel characterized by a variable and wide range of origin -it is very important to set a wide range for the scanned area.…”