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AJNR - American Journal of Neuroradiology

Published ahead of print on November 1, 2007
doi: 10.3174/ajnr.A0812

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Preoperative Visualization of the Artery of Adamkiewicz by Intra-Arterial CT Angiography

K. Uotani^a,c, N. Yamada^c, A.K. Kono^a, T. Taniguchi^a, K. Sugimoto^a, M. Fujii^a, A. Kitagawa^b, Y. Okita^b, H. Naito^c and K. Sugimura^a,d

^a Departments of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
^b Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
^c Department of Radiology, National Cardiovascular Center, Suita, Osaka, Japan
^d Department of Radiology, Kobe Red Cross Hospital, Kobe, Hyogo, Japan

View larger version (141K): [in this window] [in a new window]   Fig 1. Anatomic course of the AKA. Right anterosuperior view of a 3D volume-rendered CT image of IACTA with semitransparent skeletal system. Intercostal and lumbar arteries (1) originate from the aorta, and divide into posterior (2) and anterior (3) branches. Anterior branches run through the intercostal groove. Posterior branches subdivide into the radiculomedullary artery (4) and muscular branch (5). Radiculomedullary artery courses to the spine and enters the vertebral foramen. The AKA (6) is the largest anterior radiculomedullary artery and joins the anterior spinal artery (7) in a characteristic hairpin curve.

View larger version (84K): [in this window] [in a new window]   Fig 2. IACTA image obtained from a 68-year-old man with TAA. A, CPR of the first phase shows a hairpin curved vessel continuously to the aorta through the intercostal artery (arrow). B, On a CPR image obtained from the second phase in the same profile as that of the first phase, enhancement of this vessel is decreased. This vessel is identified as the AKA.

View larger version (72K): [in this window] [in a new window]   Fig 3. IACTA image obtained from a 77-year-old man with TAA. Oblique coronal MPR of the first (A) and second (B) phases show a hairpin curved vessel (arrows). The vessel is more enhanced in the second than in the first phase and is not connected to arteries. This vessel is identified as the radiculomedullary vein.

View larger version (107K): [in this window] [in a new window]   Fig 4. A, Oblique sagittal partial MIP image of IACTA obtained from a 73-year-old man with TAAA. Contrast material is not mixed throughout the aorta, and dorsal portion of the aorta and the intercostal or lumbar arteries (arrow) are enhanced over 1000 HU. B, Oblique sagittal partial MIP image of IVCTA obtained from a 58-year-old man with TAAA. The aorta is homogeneously enhanced, but intercostal or lumbar arteries (arrow) are poorly visualized in comparison with IACTA.

View larger version (9K): [in this window] [in a new window]   Fig 5. Laterality and levels of the AKA in all of the patients.

View larger version (103K): [in this window] [in a new window]   Fig 6. A, CPR image of the AKA obtained from IACTA. A hairpin curved vessel ascends to the midsagittal surface of the spinal cord, but continuity with the left 11th intercostal artery (arrow) is disturbed by a vertebral pedicle (arrowhead). B, Selective angiography of the left 11th intercostal artery demonstrates the AKA originating from this location.