CT angiography of the artery of Adamkiewicz with 64-section technology: first experience in children

Abstract

Background and purpose: Preoperative localization of the artery of Adamkiewicz (AKA) may be useful in selected children in prevention of ischemic spinal complications of spinal or thoracoabdominal aortic surgery. The aim of our study was to investigate the ability of 64-section CT for assessing the AKA in children.

Materials and methods: Forty children (mean age, 7.5 +/- 5 years) underwent thoracic imaging with a 64-section CT scanner after intravenous injection of 1.5 mL/kg of contrast agent. Volumetric reconstructions were obtained for every patient. Identification of the AKA was performed on the basis of continuity from the aorta to the anterior spinal artery with a characteristic hairpin turn. Identification of the AKA and determination of its origin and course were analyzed by 2 independent radiologists.

Results: The AKA was successfully visualized in 38 patients (95%). Twenty-seven (71.1%) AKAs originated on the left side, whereas 11 (28.9%) originated on the right side. It was seen to originate at the level of the left 5th intercostal artery in 1 patient, the left 8th in 4, the left 9th in 15, the left 10th in 5, the left 11th in 2, the right 8th in 2, the right 9th in 6, the right 10th in 2, and the right 12th in 1.

Conclusion: Sixty-four-section CT angiography depicted the AKA in a very high percentage (95%) of children. The results of this study suggest that 64-section CT angiography is a viable noninvasive technique that could be an alternate to selective angiography for delineating the AKA.

Figures

Fig 1.

A, Oblique coronal reconstruction allowing identification of the AKA as it makes the characteristic hairpin formation at its union with the anterior spinal artery. Note the continuity of the posterior branch of the intercostal artery and the AKA (arrows). B, Transverse image showing 2 contiguous enhanced spots (arrows) in the ventral surface of the cord, corresponding to the AKA and the anterior spinal artery. C, MIP axial reformatted image showing the continuity of the aorta, the intercostal artery, its posterior branch (arrow), and the AKA.

Fig 2.

A, Curved planar reformatted image clearly delineates the continuity of the aorta, the intercostal artery (arrow), and its posterior branch, the AKA, and the anterior spinal artery. B, Note on the volume-rendered image, the characteristic hairpin curve formation of the union of the AKA and the anterior spinal artery.