Spinal intraarterial computed tomography angiography as an effective adjunct for spinal angiography

Abstract

<jats:sec> <jats:title>OBJECT</jats:title> <jats:p>Spinal digital subtraction angiography (DSA) is indispensable for the precise diagnosis of spinal vascular lesions and the assessment of blood supply to the spinal cord. However, comprehensive spinal DSA covering multiple segments requires repetition of selective catheterization into small segmental arteries, which is time consuming, sometimes difficult, and hazardous. The authors investigated the usefulness of CT angiography with intraarterial contrast injection (IA-CTA) as a preliminary study preceding spinal DSA. With the advent of multidetector CT, it is feasible to obtain images of the spinal cord vasculature instantaneously overa number of segments.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>A total of 56 patients with lesions involving the spinal vasculature underwent IA-CTA with 64- or 320-row detector CT in advance of comprehensive spinal DSA. Contrast material was injected via a pigtail catheter placed at the aorta in proximity to the segments of interest. Scanning was repeated twice to obtain arterial- and venous-phase images to differentiate between the arterial and venous components. The spinal arteries were identified by paging the various multiplanar reconstruction images and tracing the vessels from the aorta. Spinal DSA was subsequently performed by guiding selective catheterization to the feeding segments in reference to the IA-CTA findings. Visualization of the segmental arteries, normal spinal arteries, and abnormal vessels during IA-CTA was investigated and compared with that obtained during spinal DSA.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>In all 56 patients, spinal IA-CTA successfully enabled visualization of the spinal vessels, including the radicular arteries and the anterior spinal artery. Below the aortic arch, all segmental arteries were identified clearly. The segmental arteries, radiculomedullary arteries, spinal arteries, and abnormal vessels were traced from the aorta, which would be the target of selective catheterization. In 3 (6.8%) patients, IA-CTA revealed severe aortic atherosclerosis and occlusion of some segmental arteries. The information obtained was useful for directing selective catheterization studies. The findings of IA-CTA corresponded well with those of spinal DSA.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>IA-CTA is a useful adjunct to spinal DSA for surveying the vasculature surrounding the spinal cord and for orienting selective catheterization. IA-CTA can complement spinal DSA, curtail unnecessary segmental injections, and thus reduce procedural complications.</jats:p></jats:sec>

Intracranial subarachnoid hemorrhage caused by an aneurysm at the thoracic spinal region: case report and literature review

“…T2-weighted MRI showed a mixed intensity mass lesion at the T9-10 level ( Figure 2). Spinal intraarterial CT angiography 5 and spinal angiography was performed, that revealed an aneurysm fed by the T10 radicular artery visible only at the late venous phase (Figure 3). She developed mild weakness and numbness in the left lower extremity on day 5.…”

Predictors of Adamkiewicz artery and anterior spinal artery detection through computerized tomographic angiography

“…Conventional spinal digital subtraction angiography (DSA) is a gold standard for visualization of the AKA. 28,29 Despite DSA being very sensitive in spatial detection of the AKA, CTA has a precision similar to the one achieved through magnetic resonance angiography, making CTA a clinically acceptable standard. 12,28,30,31 In face of these results, CTA is considered adequate for the pre-operative evaluation of the Adamkiewicz and anterior spinal arteries.…”