Three-Dimensional Demonstration of the Artery of Adamkiewicz With Contrast-Enhanced Magnetic Resonance Angiography

Abstract

An ascending aortic graft replacement for a Stanford type A aortic dissection was performed on a 58-year-old male. One year later the diameter of the descending aorta reached 60 mm. He was again hospitalized for a second descending aortic replacement. For preoperative assessment a contrast-enhanced magnetic resonance angiography (MRA) was requested in order to determine the level of the artery of Adamkiewicz (AdA) which supplies the anterior spinal artery. A three-dimensional (3D) fast-spoiled gradient-echo (fast-SPGR) technique with fat suppression using a 1.5T superconducting imager (Signa, GE Medical Systems, Milwaukee, WI) was applied with the voxel size being 0.50 × 0.47 × 0.44 mm. Fifteen milliliters of Gd-DTPA (Magnevist, Shering, Berlin, Germany) were injected into the antecubital vein. All the scanned data were transferred to a workstation (ZIO-M900, ZIOsoft, Tokyo, Japan). Multiplanar reconstruction (MPR), maximum intensity projections (MIP), and 3D volume rendering techniques were applied. The oblique coronal MPR image (Fig 1; T10 = tenth thoracic vertebra) illustrates the AdA (arrow) and the posterior branch of the tenth intercostal artery (arrowhead). An axial partial MIP image (Fig 2) illustrates the left tenth intercostal artery (arrow) originating from the false lumen (F) and the right tenth intercostal artery originating from the true lumen (T). A thirty-degree right anterior oblique 3D volume rendering image was obtained (Fig 3 ; the true lumen: red, the false lumen: blue, AdA and anterior spinal artery: purple). This image clearly demonstrated the continuity between the left tenth intercostal artery which originated from the false lumen and the anterior spinal artery. The detection rate of AdA in chronic dissection is 50% by MRA. Selective intercostal and lumbar arteriography was undertaken to depict preoperative anatomy although it was not indicated in the patient with a dissecting aortic aneurysm. MRA may better depict the AdA clearly and provide valuable information for surgical management.Fig 2View Large Image Figure ViewerDownload (PPT)Fig 3View Large Image Figure ViewerDownload (PPT)