Diagnostic Inefficiency of Nonselective Spinal Angiography (Flush Aortography) in the Evaluation of the Normal and Pathological Spinal Vasculature

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Selective spinal angiography was introduced in the 1960s to palliate the poor sensitivity of nonselective techniques for the evaluation of the spinal cord vasculature. Recent advances made in the field of angiography seem to have prompted a renewed interest for nonselective spinal angiography, or flush aortograms. This pictorial essay, illustrated with 2 cases of presurgical evaluation of the spinal cord supply and 2 cases of spinal vascular malformation, suggests that nonselective techniques remain insufficient to properly document the normal or pathological spinal vasculature. While flush aortography can play a role as a complement to spinal angiography, for example, to locate vessels eluding selective catheterization, relying on nonselective studies to rule out the presence of a spinal vascular malformation or to identify the normal spinal cord supply before surgical interventions may lead to false-negative investigations with potentially devastating consequences.

Section snippets

Case 1

SpDSA was requested in an adult patient with metastatic disease invading the thoracic aorta between T10 and T12 in order to characterize the spinal cord arterial supply before combined vertebral and aortic resection. The artery of Adamkiewicz was identified at right T9 (Fig 1A). A thoracic flush aortogram was obtained as the right T11 and T12 intersegmental artery (ISA) eluded selective catheterization. The aortogram confirmed the absence of the right T11 and T12 ISAs, but failed to document

Historical Background

Henson and Croft5 inaugurated the angiographic era of spinovascular disorders with a case of cervical vascular malformation documented by vertebral angiography in 1953 and published in 1956. While several sporadic observations quickly followed this initial report,6, 7, 8 it is the series of 12 cases diagnosed by Djindjian et al9 between 1960 and 1962 that firmly established angiography as the technique of choice for the exploration of spinal vascular malformations.

However, while the scope and

References (16)

  • R. Djindjian et al.

    Acquisitions récentes en angiographie médullaire

    Revue Neurologique

    (1966)
  • G. Di Chiro et al.

    Selective arteriography of arteriovenous aneurysms of spinal cord

    Radiology

    (1967)
  • J. Chiras et al.

    The dorsospinal artery. A little known anatomical variant. Its importance in spinal angiography

    J Neuroradiol

    (1979)
  • F. Siclari et al.

    Direct emergence of the dorsospinal artery from the aorta and spinal cord blood supply. Case reports and literature review

    Neuroradiology

    (2006)
  • R.A. Henson et al.

    Spontaneous spinal subarachnoid haemorrhage

    Q J Med

    (1956)
  • O. Höök et al.

    Arteriovenous aneurysms of the spinal cord; a report of two cases investigated by vertebral angiography

    J Neurosurg

    (1958)
  • R.W. Rand et al.

    Intraspinal Tumors of Childhood

    (1960)
  • A. Bergstrand et al.

    Vascular malformations of the spinal cord

    Acta Neurol Scand

    (1964)
There are more references available in the full text version of this article.

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