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MR Angiography and CT Angiography of the Artery of Adamkiewicz: State of the Art¹

¹ From the Department of Radiology (K.Y., S.E.), Second Department of Medicine (H.N., M.N.), and Department of Cardiovascular Surgery (T.N., K.K.), Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate 020-8505, Japan. Presented as an education exhibit at the 2005 RSNA Annual Meeting. Received February 7, 2006; revision requested March 14 and received April 17; accepted May 12. All authors have no financial relationships to disclose.

View larger version (105K): [in this window] [in a new window] [Download PPT slide]   Figure 1a.  Anatomy of the artery of Adamkiewicz. Anterior (a) and left anterosuperior (b) three-dimensional volume-rendered CT images, displayed with a semitransparent skeletal system, show the normal anatomy of the artery of Adamkiewicz. The thoracolumbar segment of the spinal cord is vascularized by branches of the thoracoabdominal aorta via the intercostal and lumbar arteries. The intercostal and lumbar arteries divide into anterior and posterior branches. The posterior branch subdivides into the radiculomedullary artery and the muscular branch. The radiculomedullary artery further subdivides into the anterior and posterior radiculomedullary arteries (not shown). The artery of Adamkiewicz is the largest radiculomedullary artery supplying the spinal cord and is usually found in the lower thoracic region. This artery demonstrates a characteristic "hairpin turn " at its junction with the anterior spinal artery.

 

View larger version (115K): [in this window] [in a new window] [Download PPT slide]   Figure 1b.  Anatomy of the artery of Adamkiewicz. Anterior (a) and left anterosuperior (b) three-dimensional volume-rendered CT images, displayed with a semitransparent skeletal system, show the normal anatomy of the artery of Adamkiewicz. The thoracolumbar segment of the spinal cord is vascularized by branches of the thoracoabdominal aorta via the intercostal and lumbar arteries. The intercostal and lumbar arteries divide into anterior and posterior branches. The posterior branch subdivides into the radiculomedullary artery and the muscular branch. The radiculomedullary artery further subdivides into the anterior and posterior radiculomedullary arteries (not shown). The artery of Adamkiewicz is the largest radiculomedullary artery supplying the spinal cord and is usually found in the lower thoracic region. This artery demonstrates a characteristic "hairpin turn " at its junction with the anterior spinal artery.

 

View larger version (106K): [in this window] [in a new window] [Download PPT slide]   Figure 2a.  Identification of the artery of Adamkiewicz in a 62-year-old man with a dissecting aortic aneurysm. T10 = 10th thoracic vertebra. (a, c) Oblique coronal MPR images from MR angiography (a) and CT angiography (c) show the artery of Adamkiewicz (arrow). This artery has a characteristic hairpin turn connection with the anterior spinal artery (arrowhead). (b, d) Images from MR angiography (b) and CT angiography (d), produced with curved planar reformation (CPR), show continuity of the aorta, right 10th intercostal artery (large black arrow), radiculomedullary artery (small black arrow), artery of Adamkiewicz (white arrow), and anterior spinal artery (arrowhead). DAA = dissecting aortic aneurysm.

 

View larger version (191K): [in this window] [in a new window] [Download PPT slide]   Figure 2b.  Identification of the artery of Adamkiewicz in a 62-year-old man with a dissecting aortic aneurysm. T10 = 10th thoracic vertebra. (a, c) Oblique coronal MPR images from MR angiography (a) and CT angiography (c) show the artery of Adamkiewicz (arrow). This artery has a characteristic hairpin turn connection with the anterior spinal artery (arrowhead). (b, d) Images from MR angiography (b) and CT angiography (d), produced with curved planar reformation (CPR), show continuity of the aorta, right 10th intercostal artery (large black arrow), radiculomedullary artery (small black arrow), artery of Adamkiewicz (white arrow), and anterior spinal artery (arrowhead). DAA = dissecting aortic aneurysm.

 

View larger version (77K): [in this window] [in a new window] [Download PPT slide]   Figure 2c.  Identification of the artery of Adamkiewicz in a 62-year-old man with a dissecting aortic aneurysm. T10 = 10th thoracic vertebra. (a, c) Oblique coronal MPR images from MR angiography (a) and CT angiography (c) show the artery of Adamkiewicz (arrow). This artery has a characteristic hairpin turn connection with the anterior spinal artery (arrowhead). (b, d) Images from MR angiography (b) and CT angiography (d), produced with curved planar reformation (CPR), show continuity of the aorta, right 10th intercostal artery (large black arrow), radiculomedullary artery (small black arrow), artery of Adamkiewicz (white arrow), and anterior spinal artery (arrowhead). DAA = dissecting aortic aneurysm.

 

View larger version (134K): [in this window] [in a new window] [Download PPT slide]   Figure 2d.  Identification of the artery of Adamkiewicz in a 62-year-old man with a dissecting aortic aneurysm. T10 = 10th thoracic vertebra. (a, c) Oblique coronal MPR images from MR angiography (a) and CT angiography (c) show the artery of Adamkiewicz (arrow). This artery has a characteristic hairpin turn connection with the anterior spinal artery (arrowhead). (b, d) Images from MR angiography (b) and CT angiography (d), produced with curved planar reformation (CPR), show continuity of the aorta, right 10th intercostal artery (large black arrow), radiculomedullary artery (small black arrow), artery of Adamkiewicz (white arrow), and anterior spinal artery (arrowhead). DAA = dissecting aortic aneurysm.

 

View larger version (68K): [in this window] [in a new window] [Download PPT slide]   Figure 3a.  Dissecting aortic aneurysm in a 59-year-old man. (a) Three-dimensional volume-rendered image from MR angiography (left anterior oblique view) shows a dissecting aneurysm of the thoracoabdominal aorta. (b, c) CPR images from MR angiography (b) and CT angiography (c) show continuity of the aorta, left 10th intercostal artery (large black arrow), radiculomedullary artery (small black arrow), artery of Adamkiewicz (white arrow), and anterior spinal artery (arrowhead). The 10th intercostal artery originates from the true lumen (T) of the aorta. F = false lumen, T10 = 10th thoracic vertebra.

 

View larger version (178K): [in this window] [in a new window] [Download PPT slide]   Figure 3b.  Dissecting aortic aneurysm in a 59-year-old man. (a) Three-dimensional volume-rendered image from MR angiography (left anterior oblique view) shows a dissecting aneurysm of the thoracoabdominal aorta. (b, c) CPR images from MR angiography (b) and CT angiography (c) show continuity of the aorta, left 10th intercostal artery (large black arrow), radiculomedullary artery (small black arrow), artery of Adamkiewicz (white arrow), and anterior spinal artery (arrowhead). The 10th intercostal artery originates from the true lumen (T) of the aorta. F = false lumen, T10 = 10th thoracic vertebra.

 

View larger version (132K): [in this window] [in a new window] [Download PPT slide]   Figure 3c.  Dissecting aortic aneurysm in a 59-year-old man. (a) Three-dimensional volume-rendered image from MR angiography (left anterior oblique view) shows a dissecting aneurysm of the thoracoabdominal aorta. (b, c) CPR images from MR angiography (b) and CT angiography (c) show continuity of the aorta, left 10th intercostal artery (large black arrow), radiculomedullary artery (small black arrow), artery of Adamkiewicz (white arrow), and anterior spinal artery (arrowhead). The 10th intercostal artery originates from the true lumen (T) of the aorta. F = false lumen, T10 = 10th thoracic vertebra.

 

View larger version (100K): [in this window] [in a new window] [Download PPT slide]   Figure 4a.  Dissecting aortic aneurysm in a 60-year-old man who previously underwent repair of the ascending aorta and aortic arch for acute aortic dissection. (a) Three-dimensional volume-rendered image from CT angiography (left anterior oblique view) shows a dissecting aneurysm of the thoracoabdominal aorta. (b) Axial CT image obtained at the level of the 10th thoracic vertebra (Th10) shows a small true lumen and a large false lumen. (c, d) CPR images from MR angiography (c) and CT angiography (d) show continuity of the aorta; left 10th intercostal artery (large black arrow); radiculomedullary artery (black arrowhead); artery of Adamkiewicz (white arrow in c, small black arrow in d); and anterior spinal artery (white arrowhead). The 10th intercostal artery originates from the false lumen (F). The image from CT angiography shows poor opacification of the artery of Adamkiewicz (small black arrow in d). T = true lumen, T10 = 10th thoracic vertebra.

 

View larger version (138K): [in this window] [in a new window] [Download PPT slide]   Figure 4b.  Dissecting aortic aneurysm in a 60-year-old man who previously underwent repair of the ascending aorta and aortic arch for acute aortic dissection. (a) Three-dimensional volume-rendered image from CT angiography (left anterior oblique view) shows a dissecting aneurysm of the thoracoabdominal aorta. (b) Axial CT image obtained at the level of the 10th thoracic vertebra (Th10) shows a small true lumen and a large false lumen. (c, d) CPR images from MR angiography (c) and CT angiography (d) show continuity of the aorta; left 10th intercostal artery (large black arrow); radiculomedullary artery (black arrowhead); artery of Adamkiewicz (white arrow in c, small black arrow in d); and anterior spinal artery (white arrowhead). The 10th intercostal artery originates from the false lumen (F). The image from CT angiography shows poor opacification of the artery of Adamkiewicz (small black arrow in d). T = true lumen, T10 = 10th thoracic vertebra.

 

View larger version (131K): [in this window] [in a new window] [Download PPT slide]   Figure 4c.  Dissecting aortic aneurysm in a 60-year-old man who previously underwent repair of the ascending aorta and aortic arch for acute aortic dissection. (a) Three-dimensional volume-rendered image from CT angiography (left anterior oblique view) shows a dissecting aneurysm of the thoracoabdominal aorta. (b) Axial CT image obtained at the level of the 10th thoracic vertebra (Th10) shows a small true lumen and a large false lumen. (c, d) CPR images from MR angiography (c) and CT angiography (d) show continuity of the aorta; left 10th intercostal artery (large black arrow); radiculomedullary artery (black arrowhead); artery of Adamkiewicz (white arrow in c, small black arrow in d); and anterior spinal artery (white arrowhead). The 10th intercostal artery originates from the false lumen (F). The image from CT angiography shows poor opacification of the artery of Adamkiewicz (small black arrow in d). T = true lumen, T10 = 10th thoracic vertebra.

 

View larger version (94K): [in this window] [in a new window] [Download PPT slide]   Figure 4d.  Dissecting aortic aneurysm in a 60-year-old man who previously underwent repair of the ascending aorta and aortic arch for acute aortic dissection. (a) Three-dimensional volume-rendered image from CT angiography (left anterior oblique view) shows a dissecting aneurysm of the thoracoabdominal aorta. (b) Axial CT image obtained at the level of the 10th thoracic vertebra (Th10) shows a small true lumen and a large false lumen. (c, d) CPR images from MR angiography (c) and CT angiography (d) show continuity of the aorta; left 10th intercostal artery (large black arrow); radiculomedullary artery (black arrowhead); artery of Adamkiewicz (white arrow in c, small black arrow in d); and anterior spinal artery (white arrowhead). The 10th intercostal artery originates from the false lumen (F). The image from CT angiography shows poor opacification of the artery of Adamkiewicz (small black arrow in d). T = true lumen, T10 = 10th thoracic vertebra.

 

View larger version (91K): [in this window] [in a new window] [Download PPT slide]   Figure 5a.  Demonstration of collateral circulation to the artery of Adamkiewicz in a 78-year-old man with a true thoracoabdominal aortic aneurysm. TAAA = thoracoabdominal aortic aneurysm, T10 = 10th thoracic vertebra, T11 = 11th thoracic vertebra. (a) Oblique coronal MPR image from MR angiography shows the artery of Adamkiewicz (white arrowhead) branching from the left 10th intercostal artery and anterior spinal artery (black arrowhead). (b) On an axial partial MIP image from MR angiography, the proximal portion (large arrow) of the left 10th intercostal artery (small arrow) cannot be visualized. (c) Oblique sagittal partial MIP image from MR angiography shows two collateral arteries: a small ventral artery (small white arrow) and a large dorsal artery (large white arrow). They extend from the left 11th intercostal artery (large black arrow) to the left 10th intercostal artery (small black arrow) via muscular branches. (d, e) CPR images from MR angiography (d) and CT angiography (e) show continuity of the aorta, left 11th intercostal artery (large black arrow), small ventral collateral artery (long white arrow), left 10th intercostal artery (small black arrow), anterior radiculomedullary artery (short white arrow), artery of Adamkiewicz (white arrowhead), and anterior spinal artery (black arrowhead). (f, g) CPR images from MR angiography (f ) and CT angiography (g) show continuity of the aorta, left 11th intercostal artery (large black arrow), large dorsal collateral artery (large white arrow), left 10th intercostal artery (small black arrow), radiculomedullary artery (small white arrow), artery of Adamkiewicz (white arrowhead), and anterior spinal artery (black arrowhead). (h) Three-dimensional volume-rendered image from CT angiography (left anterior oblique view), displayed with a semitransparent skeletal system and aorta, shows the entire collateral circulation via the two muscular branches: the small ventral artery (small arrow) and the large dorsal artery (large arrow). Thus, there is continuity from the aorta to the artery of Adamkiewicz (white arrowhead) and anterior spinal artery (black arrowhead).

 

View larger version (82K): [in this window] [in a new window] [Download PPT slide]   Figure 5b.  Demonstration of collateral circulation to the artery of Adamkiewicz in a 78-year-old man with a true thoracoabdominal aortic aneurysm. TAAA = thoracoabdominal aortic aneurysm, T10 = 10th thoracic vertebra, T11 = 11th thoracic vertebra. (a) Oblique coronal MPR image from MR angiography shows the artery of Adamkiewicz (white arrowhead) branching from the left 10th intercostal artery and anterior spinal artery (black arrowhead). (b) On an axial partial MIP image from MR angiography, the proximal portion (large arrow) of the left 10th intercostal artery (small arrow) cannot be visualized. (c) Oblique sagittal partial MIP image from MR angiography shows two collateral arteries: a small ventral artery (small white arrow) and a large dorsal artery (large white arrow). They extend from the left 11th intercostal artery (large black arrow) to the left 10th intercostal artery (small black arrow) via muscular branches. (d, e) CPR images from MR angiography (d) and CT angiography (e) show continuity of the aorta, left 11th intercostal artery (large black arrow), small ventral collateral artery (long white arrow), left 10th intercostal artery (small black arrow), anterior radiculomedullary artery (short white arrow), artery of Adamkiewicz (white arrowhead), and anterior spinal artery (black arrowhead). (f, g) CPR images from MR angiography (f ) and CT angiography (g) show continuity of the aorta, left 11th intercostal artery (large black arrow), large dorsal collateral artery (large white arrow), left 10th intercostal artery (small black arrow), radiculomedullary artery (small white arrow), artery of Adamkiewicz (white arrowhead), and anterior spinal artery (black arrowhead). (h) Three-dimensional volume-rendered image from CT angiography (left anterior oblique view), displayed with a semitransparent skeletal system and aorta, shows the entire collateral circulation via the two muscular branches: the small ventral artery (small arrow) and the large dorsal artery (large arrow). Thus, there is continuity from the aorta to the artery of Adamkiewicz (white arrowhead) and anterior spinal artery (black arrowhead).

 

View larger version (170K): [in this window] [in a new window] [Download PPT slide]   Figure 5c.  Demonstration of collateral circulation to the artery of Adamkiewicz in a 78-year-old man with a true thoracoabdominal aortic aneurysm. TAAA = thoracoabdominal aortic aneurysm, T10 = 10th thoracic vertebra, T11 = 11th thoracic vertebra. (a) Oblique coronal MPR image from MR angiography shows the artery of Adamkiewicz (white arrowhead) branching from the left 10th intercostal artery and anterior spinal artery (black arrowhead). (b) On an axial partial MIP image from MR angiography, the proximal portion (large arrow) of the left 10th intercostal artery (small arrow) cannot be visualized. (c) Oblique sagittal partial MIP image from MR angiography shows two collateral arteries: a small ventral artery (small white arrow) and a large dorsal artery (large white arrow). They extend from the left 11th intercostal artery (large black arrow) to the left 10th intercostal artery (small black arrow) via muscular branches. (d, e) CPR images from MR angiography (d) and CT angiography (e) show continuity of the aorta, left 11th intercostal artery (large black arrow), small ventral collateral artery (long white arrow), left 10th intercostal artery (small black arrow), anterior radiculomedullary artery (short white arrow), artery of Adamkiewicz (white arrowhead), and anterior spinal artery (black arrowhead). (f, g) CPR images from MR angiography (f ) and CT angiography (g) show continuity of the aorta, left 11th intercostal artery (large black arrow), large dorsal collateral artery (large white arrow), left 10th intercostal artery (small black arrow), radiculomedullary artery (small white arrow), artery of Adamkiewicz (white arrowhead), and anterior spinal artery (black arrowhead). (h) Three-dimensional volume-rendered image from CT angiography (left anterior oblique view), displayed with a semitransparent skeletal system and aorta, shows the entire collateral circulation via the two muscular branches: the small ventral artery (small arrow) and the large dorsal artery (large arrow). Thus, there is continuity from the aorta to the artery of Adamkiewicz (white arrowhead) and anterior spinal artery (black arrowhead).

 

View larger version (196K): [in this window] [in a new window] [Download PPT slide]   Figure 5d.  Demonstration of collateral circulation to the artery of Adamkiewicz in a 78-year-old man with a true thoracoabdominal aortic aneurysm. TAAA = thoracoabdominal aortic aneurysm, T10 = 10th thoracic vertebra, T11 = 11th thoracic vertebra. (a) Oblique coronal MPR image from MR angiography shows the artery of Adamkiewicz (white arrowhead) branching from the left 10th intercostal artery and anterior spinal artery (black arrowhead). (b) On an axial partial MIP image from MR angiography, the proximal portion (large arrow) of the left 10th intercostal artery (small arrow) cannot be visualized. (c) Oblique sagittal partial MIP image from MR angiography shows two collateral arteries: a small ventral artery (small white arrow) and a large dorsal artery (large white arrow). They extend from the left 11th intercostal artery (large black arrow) to the left 10th intercostal artery (small black arrow) via muscular branches. (d, e) CPR images from MR angiography (d) and CT angiography (e) show continuity of the aorta, left 11th intercostal artery (large black arrow), small ventral collateral artery (long white arrow), left 10th intercostal artery (small black arrow), anterior radiculomedullary artery (short white arrow), artery of Adamkiewicz (white arrowhead), and anterior spinal artery (black arrowhead). (f, g) CPR images from MR angiography (f ) and CT angiography (g) show continuity of the aorta, left 11th intercostal artery (large black arrow), large dorsal collateral artery (large white arrow), left 10th intercostal artery (small black arrow), radiculomedullary artery (small white arrow), artery of Adamkiewicz (white arrowhead), and anterior spinal artery (black arrowhead). (h) Three-dimensional volume-rendered image from CT angiography (left anterior oblique view), displayed with a semitransparent skeletal system and aorta, shows the entire collateral circulation via the two muscular branches: the small ventral artery (small arrow) and the large dorsal artery (large arrow). Thus, there is continuity from the aorta to the artery of Adamkiewicz (white arrowhead) and anterior spinal artery (black arrowhead).

 

View larger version (111K): [in this window] [in a new window] [Download PPT slide]   Figure 5e.  Demonstration of collateral circulation to the artery of Adamkiewicz in a 78-year-old man with a true thoracoabdominal aortic aneurysm. TAAA = thoracoabdominal aortic aneurysm, T10 = 10th thoracic vertebra, T11 = 11th thoracic vertebra. (a) Oblique coronal MPR image from MR angiography shows the artery of Adamkiewicz (white arrowhead) branching from the left 10th intercostal artery and anterior spinal artery (black arrowhead). (b) On an axial partial MIP image from MR angiography, the proximal portion (large arrow) of the left 10th intercostal artery (small arrow) cannot be visualized. (c) Oblique sagittal partial MIP image from MR angiography shows two collateral arteries: a small ventral artery (small white arrow) and a large dorsal artery (large white arrow). They extend from the left 11th intercostal artery (large black arrow) to the left 10th intercostal artery (small black arrow) via muscular branches. (d, e) CPR images from MR angiography (d) and CT angiography (e) show continuity of the aorta, left 11th intercostal artery (large black arrow), small ventral collateral artery (long white arrow), left 10th intercostal artery (small black arrow), anterior radiculomedullary artery (short white arrow), artery of Adamkiewicz (white arrowhead), and anterior spinal artery (black arrowhead). (f, g) CPR images from MR angiography (f ) and CT angiography (g) show continuity of the aorta, left 11th intercostal artery (large black arrow), large dorsal collateral artery (large white arrow), left 10th intercostal artery (small black arrow), radiculomedullary artery (small white arrow), artery of Adamkiewicz (white arrowhead), and anterior spinal artery (black arrowhead). (h) Three-dimensional volume-rendered image from CT angiography (left anterior oblique view), displayed with a semitransparent skeletal system and aorta, shows the entire collateral circulation via the two muscular branches: the small ventral artery (small arrow) and the large dorsal artery (large arrow). Thus, there is continuity from the aorta to the artery of Adamkiewicz (white arrowhead) and anterior spinal artery (black arrowhead).

 

View larger version (161K): [in this window] [in a new window] [Download PPT slide]   Figure 5f.  Demonstration of collateral circulation to the artery of Adamkiewicz in a 78-year-old man with a true thoracoabdominal aortic aneurysm. TAAA = thoracoabdominal aortic aneurysm, T10 = 10th thoracic vertebra, T11 = 11th thoracic vertebra. (a) Oblique coronal MPR image from MR angiography shows the artery of Adamkiewicz (white arrowhead) branching from the left 10th intercostal artery and anterior spinal artery (black arrowhead). (b) On an axial partial MIP image from MR angiography, the proximal portion (large arrow) of the left 10th intercostal artery (small arrow) cannot be visualized. (c) Oblique sagittal partial MIP image from MR angiography shows two collateral arteries: a small ventral artery (small white arrow) and a large dorsal artery (large white arrow). They extend from the left 11th intercostal artery (large black arrow) to the left 10th intercostal artery (small black arrow) via muscular branches. (d, e) CPR images from MR angiography (d) and CT angiography (e) show continuity of the aorta, left 11th intercostal artery (large black arrow), small ventral collateral artery (long white arrow), left 10th intercostal artery (small black arrow), anterior radiculomedullary artery (short white arrow), artery of Adamkiewicz (white arrowhead), and anterior spinal artery (black arrowhead). (f, g) CPR images from MR angiography (f ) and CT angiography (g) show continuity of the aorta, left 11th intercostal artery (large black arrow), large dorsal collateral artery (large white arrow), left 10th intercostal artery (small black arrow), radiculomedullary artery (small white arrow), artery of Adamkiewicz (white arrowhead), and anterior spinal artery (black arrowhead). (h) Three-dimensional volume-rendered image from CT angiography (left anterior oblique view), displayed with a semitransparent skeletal system and aorta, shows the entire collateral circulation via the two muscular branches: the small ventral artery (small arrow) and the large dorsal artery (large arrow). Thus, there is continuity from the aorta to the artery of Adamkiewicz (white arrowhead) and anterior spinal artery (black arrowhead).

 

View larger version (114K): [in this window] [in a new window] [Download PPT slide]   Figure 5g.  Demonstration of collateral circulation to the artery of Adamkiewicz in a 78-year-old man with a true thoracoabdominal aortic aneurysm. TAAA = thoracoabdominal aortic aneurysm, T10 = 10th thoracic vertebra, T11 = 11th thoracic vertebra. (a) Oblique coronal MPR image from MR angiography shows the artery of Adamkiewicz (white arrowhead) branching from the left 10th intercostal artery and anterior spinal artery (black arrowhead). (b) On an axial partial MIP image from MR angiography, the proximal portion (large arrow) of the left 10th intercostal artery (small arrow) cannot be visualized. (c) Oblique sagittal partial MIP image from MR angiography shows two collateral arteries: a small ventral artery (small white arrow) and a large dorsal artery (large white arrow). They extend from the left 11th intercostal artery (large black arrow) to the left 10th intercostal artery (small black arrow) via muscular branches. (d, e) CPR images from MR angiography (d) and CT angiography (e) show continuity of the aorta, left 11th intercostal artery (large black arrow), small ventral collateral artery (long white arrow), left 10th intercostal artery (small black arrow), anterior radiculomedullary artery (short white arrow), artery of Adamkiewicz (white arrowhead), and anterior spinal artery (black arrowhead). (f, g) CPR images from MR angiography (f ) and CT angiography (g) show continuity of the aorta, left 11th intercostal artery (large black arrow), large dorsal collateral artery (large white arrow), left 10th intercostal artery (small black arrow), radiculomedullary artery (small white arrow), artery of Adamkiewicz (white arrowhead), and anterior spinal artery (black arrowhead). (h) Three-dimensional volume-rendered image from CT angiography (left anterior oblique view), displayed with a semitransparent skeletal system and aorta, shows the entire collateral circulation via the two muscular branches: the small ventral artery (small arrow) and the large dorsal artery (large arrow). Thus, there is continuity from the aorta to the artery of Adamkiewicz (white arrowhead) and anterior spinal artery (black arrowhead).

 

View larger version (156K): [in this window] [in a new window] [Download PPT slide]   Figure 5h.  Demonstration of collateral circulation to the artery of Adamkiewicz in a 78-year-old man with a true thoracoabdominal aortic aneurysm. TAAA = thoracoabdominal aortic aneurysm, T10 = 10th thoracic vertebra, T11 = 11th thoracic vertebra. (a) Oblique coronal MPR image from MR angiography shows the artery of Adamkiewicz (white arrowhead) branching from the left 10th intercostal artery and anterior spinal artery (black arrowhead). (b) On an axial partial MIP image from MR angiography, the proximal portion (large arrow) of the left 10th intercostal artery (small arrow) cannot be visualized. (c) Oblique sagittal partial MIP image from MR angiography shows two collateral arteries: a small ventral artery (small white arrow) and a large dorsal artery (large white arrow). They extend from the left 11th intercostal artery (large black arrow) to the left 10th intercostal artery (small black arrow) via muscular branches. (d, e) CPR images from MR angiography (d) and CT angiography (e) show continuity of the aorta, left 11th intercostal artery (large black arrow), small ventral collateral artery (long white arrow), left 10th intercostal artery (small black arrow), anterior radiculomedullary artery (short white arrow), artery of Adamkiewicz (white arrowhead), and anterior spinal artery (black arrowhead). (f, g) CPR images from MR angiography (f ) and CT angiography (g) show continuity of the aorta, left 11th intercostal artery (large black arrow), large dorsal collateral artery (large white arrow), left 10th intercostal artery (small black arrow), radiculomedullary artery (small white arrow), artery of Adamkiewicz (white arrowhead), and anterior spinal artery (black arrowhead). (h) Three-dimensional volume-rendered image from CT angiography (left anterior oblique view), displayed with a semitransparent skeletal system and aorta, shows the entire collateral circulation via the two muscular branches: the small ventral artery (small arrow) and the large dorsal artery (large arrow). Thus, there is continuity from the aorta to the artery of Adamkiewicz (white arrowhead) and anterior spinal artery (black arrowhead).

 

View larger version (61K): [in this window] [in a new window] [Download PPT slide]   Figure 6a.  Differentiation of the artery of Adamkiewicz from the anterior radiculomedullary vein. These vessels have similar morphologic characteristics, making it difficult to distinguish between them. It is essential to demonstrate the continuity between the aorta and the anterior spinal artery. T11 = 11th thoracic vertebra. (a) Oblique coronal MPR image from arterial phase CT angiography shows a vessel with a hairpin turn configuration (arrow) at the level of the 11th thoracic vertebra. (b) Oblique coronal MPR image from venous phase CT angiography shows a vessel with a hairpin turn configuration (arrowhead) at the level of the 12th thoracic vertebra. (c) Oblique coronal MPR image from late arterial phase CT angiography shows the two vessels with hairpin turn configurations (arrow, arrowhead). (d) CPR image from CT angiography clearly shows continuity of the aorta (Ao), left 11th intercostal artery (large black arrow), anterior radiculomedullary artery (white arrow), artery of Adamkiewicz (small black arrow), and anterior spinal artery (arrowhead). (e) Image from selective digital subtraction angiography of the left 11th intercostal artery (large arrow) shows the artery of Adamkiewicz (small arrow) and anterior spinal artery (arrowhead). Selective digital subtraction angiography of the left 12th intercostal artery showed no connection with the artery of Adamkiewicz.

 

View larger version (64K): [in this window] [in a new window] [Download PPT slide]   Figure 6b.  Differentiation of the artery of Adamkiewicz from the anterior radiculomedullary vein. These vessels have similar morphologic characteristics, making it difficult to distinguish between them. It is essential to demonstrate the continuity between the aorta and the anterior spinal artery. T11 = 11th thoracic vertebra. (a) Oblique coronal MPR image from arterial phase CT angiography shows a vessel with a hairpin turn configuration (arrow) at the level of the 11th thoracic vertebra. (b) Oblique coronal MPR image from venous phase CT angiography shows a vessel with a hairpin turn configuration (arrowhead) at the level of the 12th thoracic vertebra. (c) Oblique coronal MPR image from late arterial phase CT angiography shows the two vessels with hairpin turn configurations (arrow, arrowhead). (d) CPR image from CT angiography clearly shows continuity of the aorta (Ao), left 11th intercostal artery (large black arrow), anterior radiculomedullary artery (white arrow), artery of Adamkiewicz (small black arrow), and anterior spinal artery (arrowhead). (e) Image from selective digital subtraction angiography of the left 11th intercostal artery (large arrow) shows the artery of Adamkiewicz (small arrow) and anterior spinal artery (arrowhead). Selective digital subtraction angiography of the left 12th intercostal artery showed no connection with the artery of Adamkiewicz.

 

View larger version (63K): [in this window] [in a new window] [Download PPT slide]   Figure 6c.  Differentiation of the artery of Adamkiewicz from the anterior radiculomedullary vein. These vessels have similar morphologic characteristics, making it difficult to distinguish between them. It is essential to demonstrate the continuity between the aorta and the anterior spinal artery. T11 = 11th thoracic vertebra. (a) Oblique coronal MPR image from arterial phase CT angiography shows a vessel with a hairpin turn configuration (arrow) at the level of the 11th thoracic vertebra. (b) Oblique coronal MPR image from venous phase CT angiography shows a vessel with a hairpin turn configuration (arrowhead) at the level of the 12th thoracic vertebra. (c) Oblique coronal MPR image from late arterial phase CT angiography shows the two vessels with hairpin turn configurations (arrow, arrowhead). (d) CPR image from CT angiography clearly shows continuity of the aorta (Ao), left 11th intercostal artery (large black arrow), anterior radiculomedullary artery (white arrow), artery of Adamkiewicz (small black arrow), and anterior spinal artery (arrowhead). (e) Image from selective digital subtraction angiography of the left 11th intercostal artery (large arrow) shows the artery of Adamkiewicz (small arrow) and anterior spinal artery (arrowhead). Selective digital subtraction angiography of the left 12th intercostal artery showed no connection with the artery of Adamkiewicz.

 

View larger version (98K): [in this window] [in a new window] [Download PPT slide]   Figure 6d.  Differentiation of the artery of Adamkiewicz from the anterior radiculomedullary vein. These vessels have similar morphologic characteristics, making it difficult to distinguish between them. It is essential to demonstrate the continuity between the aorta and the anterior spinal artery. T11 = 11th thoracic vertebra. (a) Oblique coronal MPR image from arterial phase CT angiography shows a vessel with a hairpin turn configuration (arrow) at the level of the 11th thoracic vertebra. (b) Oblique coronal MPR image from venous phase CT angiography shows a vessel with a hairpin turn configuration (arrowhead) at the level of the 12th thoracic vertebra. (c) Oblique coronal MPR image from late arterial phase CT angiography shows the two vessels with hairpin turn configurations (arrow, arrowhead). (d) CPR image from CT angiography clearly shows continuity of the aorta (Ao), left 11th intercostal artery (large black arrow), anterior radiculomedullary artery (white arrow), artery of Adamkiewicz (small black arrow), and anterior spinal artery (arrowhead). (e) Image from selective digital subtraction angiography of the left 11th intercostal artery (large arrow) shows the artery of Adamkiewicz (small arrow) and anterior spinal artery (arrowhead). Selective digital subtraction angiography of the left 12th intercostal artery showed no connection with the artery of Adamkiewicz.

 

View larger version (110K): [in this window] [in a new window] [Download PPT slide]   Figure 6e.  Differentiation of the artery of Adamkiewicz from the anterior radiculomedullary vein. These vessels have similar morphologic characteristics, making it difficult to distinguish between them. It is essential to demonstrate the continuity between the aorta and the anterior spinal artery. T11 = 11th thoracic vertebra. (a) Oblique coronal MPR image from arterial phase CT angiography shows a vessel with a hairpin turn configuration (arrow) at the level of the 11th thoracic vertebra. (b) Oblique coronal MPR image from venous phase CT angiography shows a vessel with a hairpin turn configuration (arrowhead) at the level of the 12th thoracic vertebra. (c) Oblique coronal MPR image from late arterial phase CT angiography shows the two vessels with hairpin turn configurations (arrow, arrowhead). (d) CPR image from CT angiography clearly shows continuity of the aorta (Ao), left 11th intercostal artery (large black arrow), anterior radiculomedullary artery (white arrow), artery of Adamkiewicz (small black arrow), and anterior spinal artery (arrowhead). (e) Image from selective digital subtraction angiography of the left 11th intercostal artery (large arrow) shows the artery of Adamkiewicz (small arrow) and anterior spinal artery (arrowhead). Selective digital subtraction angiography of the left 12th intercostal artery showed no connection with the artery of Adamkiewicz.

 

View larger version (130K): [in this window] [in a new window] [Download PPT slide]   Figure 7a.  Limitation of CT angiography in a 70-year-old woman with a true aortic aneurysm. CPR images from CT angiography (a) and MR angiography (b) show normal osseous structures, an osteophyte, and scoliosis, which may obscure the artery of Adamkiewicz (large arrow) at CT angiography. Ao = aorta, L1 = first lumbar vertebra, arrowhead = anterior spinal artery, small arrow = left first lumbar artery.

 

View larger version (199K): [in this window] [in a new window] [Download PPT slide]   Figure 7b.  Limitation of CT angiography in a 70-year-old woman with a true aortic aneurysm. CPR images from CT angiography (a) and MR angiography (b) show normal osseous structures, an osteophyte, and scoliosis, which may obscure the artery of Adamkiewicz (large arrow) at CT angiography. Ao = aorta, L1 = first lumbar vertebra, arrowhead = anterior spinal artery, small arrow = left first lumbar artery.

 

View larger version (155K): [in this window] [in a new window] [Download PPT slide]   Figure 8.  Limitation of MR angiography in a 74-year-old man with a true aortic aneurysm. Anterior three-dimensional volume-rendered image from CT angiography, displayed with the aorta digitally eliminated, shows a collateral vessel (arrow) from the left ninth intercostal artery to the left 10th intercostal artery. The box indicates the field of view in MR angiography. Because the field of view of MR angiography is limited in sagittal imaging, some collateral vessels are not visualized at MR angiography. T9 = ninth thoracic vertebra, T10 = 10th thoracic vertebra.

 

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