CTA of the Spinal Arteries

Abstract

AbstractSince vascular and nonvascular interventions in the vicinity of the spinal cord are challenged by the risk of spinal ischemia, cross-sectional imaging of spinal blood supply is gaining clinical importance. By identifying significant spinal feeders, spinal artery imaging using MDCT angiography can act as a roadmap for selecting an adequate surgical or interventional procedure, possibly including a preceded reimplantation of relevant spinal arteries or customization of the applied technique. The main spinal feeding artery is, in general, the Adamkiewicz artery, which is an anterior radicular ramus arising from a segmental aortic branch at the thoracolumbar region and supplies the anterior two thirds of the spinal cord. Visualization of tenuous spinal arteries necessitates an adapted scanning protocol that combines high spatial resolution with optimized contrast enhancement. Using a thin collimation and low pitch value as well as an increased iodine dosage, spinal feeding arteries can be depicted reliably. Additional image postprocessing with adjustment of MPRs and MIPs improves evaluation of spinal vasculature. Interestingly, even after aortic stenting for endovascular aneurysm treatment, depiction of related spinal arteries may still be demonstrated, suggesting sufficient circumventing pathways that maintain spinal perfusion in individual cases.KeywordsLumbar ArteryAnterior Spinal ArteryThoracoabdominal Aortic AneurysmVertebral Venous PlexusRadicular ArteryThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.