MRA of the Adamkiewicz Artery: A Preoperative Study for Thoracic Aortic Aneurysm

Yamada, Naoaki; Takamiya, Makoto; Kuribayashi, Sachio; Okita, Yutaka; Minatoya, Kenji; Tanaka, Ryoichi

doi:10.1097/00004728-200005000-00002

Cited by 80 publications

(43 citation statements)

References 17 publications

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“…7 Recent advances in MR and CT angiography were first demonstrated at Japanese research sites. 8,9 From that point, techniques have strongly improved vessel-to-background contrast by using fast acquisition in combination with contrast agent bolus injection and are now able to depict and differentiate normal spinal cord arteries and veins.…”

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confidence: 99%

Advances in Spinal Cord MR Angiography

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Nijenhuis²

2008

AJNR Am J Neuroradiol

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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...

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confidence: 99%

Advances in Spinal Cord MR Angiography

Backes

Nijenhuis²

2008

AJNR Am J Neuroradiol

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“…With recent advances in MR angiography and CT angiography technologies, CT angiography and MR angiography have gained acceptance as effective and noninvasive alternative methods that allow visualization of the AKA and the ASA. According to several previous reports [12,13], the AKA was detected in 69% to 84% of patients by MR angiography without any complications. Furthermore, the use of both MR angiography and CT angiography can provide a very high detection rate of 90% for the AKA, which is superior to that of conventional selective spinal cord angiography [8].…”

Section: Discussionmentioning

confidence: 76%

“…For preoperative identifi cation of the AKA and the ASA, several angiographic techniques including selective spinal cord angiography [5,6], MR angiography [12,13], and CT angiography [7][8][9][10][11] B) A 2D curved-MPR demonstrates connection from aorta to anterior spinal artery by the AKA, and its continuity through the collateral circulation ( * ). Red arrow points to AKA.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have shown that selective spinal cord angiography [5,6], multi-detector row computed tomography (CT) angiography [7][8][9][10][11], and magnetic resonance (MR) angiography [12,13] are useful for identifying the AKA and the ASA preoperatively. However, the visualization of the AKA and of the continuity between the aorta and the ASA with these techniques may not be adequate to prevent spinal cord ischemia after surgery.…”

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confidence: 99%

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Preoperative Visualization of the Artery of Adamkiewicz by Dual-Phase CT Angiography in Patients with Aortic Aneurysm

et al. 2011

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2009

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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.

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MRA of the Adamkiewicz Artery: A Preoperative Study for Thoracic Aortic Aneurysm

Abstract: Contrast MRA is a promising technique to visualize the AKA noninvasively as a preoperative evaluation of thoracic aortic aneurysms.

Cited by 80 publications

References 17 publications

Advances in Spinal Cord MR Angiography

Advances in Spinal Cord MR Angiography

Preoperative Visualization of the Artery of Adamkiewicz by Dual-Phase CT Angiography in Patients with Aortic Aneurysm

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

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