MDCT scan visualizes the adamkiewicz artery

Abstract

Ischemic spinal cord injury is a serious complication after surgical repair of descending thoracic or thoracoabdominal aortic aneurysm. The Adamkiewicz artery (arteria radicularis magna [ARM]) is well known as a main feeder of the spinal cord. It originates from a segment of the intercostal or lumbar artery. The anatomical information of the ARM is important in conducting surgical strategy and may reduce the risk of postoperative neurologic deficit. To detect the ARM, selective angiography and magnetic resonance angiography have been used and reported to identify the ARM in 70% to 80% of patients. Alternatively, we have adopted a fourchannel multi-detector row computed tomographic (MDCT) scan that could successfully visualize the ARM. A 70-year-old man with a dissecting thoracoabdominal aortic aneurysm (DeBakey type IIIb; maximal diameter, 60 mm) underwent MDCT scan, as seen in this helical computed tomographic image (Fig 1A). The axial computed tomographic image shows the aneurysm that it is 60 mm in maximal diameter (Fig 1B). The study revealed the ARM originating from the left L1 lumbar artery and connecting to the anterior spinal artery with the classic “hairpin” bend, as seen in this preoperative MDCT scan with coronal reformation (Fig 2 [ASA aspirin]). His surgical repair consisted of aneurysmectomy and graft replacement with the reconstruction of the left T8 and T10 intercostal arteries, the left L1 lumbar artery, the celiac artery, the superior mesenteric artery, and the bilateral renal arteries. To minimize the duration of spinal cord ischemia, the left L1 lumbar artery was reconstructed first. The postoperative MDCT scan after the operation showed that the ARM was successfully reconstructed (Fig 3) and no neurologic complication was noticed. The MDCT scan was acquired under a protocol approved by our institutional review board. Computed tomographic images were obtained while injecting 100 mL of 350 mg/dL iodinated contrast medium at a flow rate of 5 mL per second through the right antecubital vein. A 0.5 second tube-detectors rotation time and helical pitch 5 were used. The patient was requested to breathe quietly during the scan. All computed tomographic data were processed in our three-dimensional imaging workstation to get sagittal and coronal reformations of 1-mm thickness. The MDCT scan is noninvasive to visualize the ARM and helpful in surgical repair of the descending thoracic or thoracoabdominal aortic aneurysm. Moreover, this study is economically acceptable and is not time consuming. Address reprint requests to Dr Shiiya, Department of Cardiovascular Surgery, Hokkaido University School of Medicine, Kita 14, Nishi 5, Kita-ku, Sapporo, Hokkaido 060-8648, Japan; e-mail: shiyanor@ med.hokudai.ac.jp. Fig 1.