Usefulness of Preoperative Detection of Artery of Adamkiewicz with Dynamic Contrast-enhanced MR Angiography

Hyodoh, Hideki; Kawaharada, Nobuyoshi; Akiba, Hidenari; Tamakawa, Mitsuharu; Hyodoh, Kazusa; Fukada, Johji; Morishita, Kiyofumi; Hareyama, Masato

doi:10.1148/radiol.2363040911

Cited by 75 publications

(60 citation statements)

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“…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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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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. Therefore, in the surgical approach, 2 methods are used to maintain the blood ‰ow to the artery of Adamkiewicz.…”

Section: Discussionmentioning

confidence: 99%

“…The criteria for detection of the artery of Adamkiewicz in both the original and the 3D-MIP images were as previously reported: 5,7 1) depiction of a clearly deˆned blood vessel connected to the radiculomedullary or lumbar artery in the early phase, 2) depiction of a blood vessel running toward the anterior spinal cord with a hairpin-turn connection in the early phase, and 3) diminished signal intensity of this vessel in the late phase. Using curved MPR images, the vertebral level of ar- terial branching from the aorta and the level at the intervertebral foramen were also evaluated.…”

Section: Detection Criteriamentioning

confidence: 99%

“…Recent studies have reported that the rate of spinal cord ischemia was signiˆcantly decreased in patients who underwent successful preoperative identiˆca-tion of the artery of Adamkiewicz (also known as the great anterior radiculomedullary artery and the dominant arterial feeder of the spinal cord) compared to patients in whom this artery was not identiˆed. 4,5 Greenberg's group reported on neurologic deˆcit caused by spinal cord ischemia in 3 of 25 patients (12z) undergoing endovascular thoracoabdominal aneurysm repair, with long-segment thoracic aortic coverage found to be a signiˆcant risk factor in predicting clinically evident spinal cord ischemia.…”

Section: Introductionmentioning

confidence: 99%

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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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Analysis of spinal cord blood supply combining vascular corrosion casting and fluorescence microsphere technique: A feasibility study in an aortic surgical large animal model

et al. 2020

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Introduction Spinal cord ischemia after cardiovascular interventions continues to be a devastating problem in modern surgery. The role of intraspinal vascular networks and anterior radiculomedullary arteries (ARMA) in preventing spinal cord ischemia is poorly understood. Materials and methods Landrace pigs (n = 30, 35.1 ± 3.9 kg) underwent a lateral thoracotomy. Fluorescent microspheres were injected into the left atrium and a reference sample was aspirated from the descending aorta. Repeated measurements of spinal cord and renal cortical blood flow from the left and right kidneys with three different microsphere colors in five pigs were taken to validate reproducibility. Spinal cord blood flow to the upper thoracic (T1–T4), mid‐thoracic (T5–T8), lower thoracic (T9–T13), and lumbar (L1–L3) levels were determined. After euthanasia, we carried out selective vascular corrosion cast and counted the left and right ARMAs from levels T1–T13. Results Blood flow analysis of the left and right kidneys revealed a strong correlation (r = .94, p < .001). We detected more left than right ARMAs, with the highest prevalence at T4 (p < .05). The mean number of ARMAs was 8 ± 2. Their number in the upper thoracic region ranged from 2 to 7 (mean of 5 ± 1), while in the lower thoracic region they ranged from 0 to 5 (mean of 3 ± 1 [p < .001]). Conclusions This study shows that combining fluorescence microsphere technique and vascular corrosion cast is well suited for assessing the blood flow and visualizing the arteries at the same time.

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Usefulness of Preoperative Detection of Artery of Adamkiewicz with Dynamic Contrast-enhanced MR Angiography

Abstract: The artery of Adamkiewicz was detected in a large percentage of patients in whom there were no spinal complications, unlike the spinal complications that occurred in the patients in whom the artery was not detected.

Cited by 75 publications

References 19 publications

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

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

Analysis of spinal cord blood supply combining vascular corrosion casting and fluorescence microsphere technique: A feasibility study in an aortic surgical large animal model

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