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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).
