Ann Thorac Surg 2006;81:749
© 2006 The Society of Thoracic Surgeons
Images in cardiothoracic surgery
Three-Dimensional Demonstration of the Collateral Circulation to the Artery of Adamkiewicz With 16-Row Multislice Computed Tomography
Kunihiro Yoshioka, MD
a
,
*
,
Hiroyuki Niinuma, MD
b
,
Yoshinobu Ogino, MD
b
,
Kenta Muranaka, RT
a
,
Kohei Kawazoe, MD
c
,
Shigeru Ehara, MD
a
a Department of Radiology, Memorial Heart Center, Iwate Medical University, Iwate, Japan
c Department of Cardiovascular Surgery, Memorial Heart Center, Iwate Medical University, Iwate, Japan
b Department of Internal Medicine II, Iwate Medical University, Iwate, Japan
* Address correspondence to Dr Yoshioka, Department of Radiology, Memorial Heart Center, Iwate Medical University, 19-1, Uchimaru, Morioka, Iwate, 020-8505, Japan (Email: kyoshi{at}iwate-med.ac.jp).
A 74-year-old man who had a previous repair of an infrarenal abdominal aortic aneurysm was scheduled to undergo the repair of a 6.5-cm thoracic aortic aneurysm. For preoperative assessment, a three-dimensional computed tomographic (CT) angiogram was obtained using a 16-row multislice CT scanner (Aquilion 16, Toshiba, Tokyo, Japan). The scan was performed from the seventh thoracic vertebra to the second lumbar vertebra with a slice thickness of 0.5 mm after the injection of low-osmolarity contrast medium into the right antecubital vein.
Three-dimensional volume rendering (VR) images and curved planar reformatted (CPR) images were obtained on a workstation (ZIO M900, Ziosoft, Tokyo, Japan). The left anterior oblique three-dimensional VR image (Fig 1), with semitransparent skeletal system and aorta, shows that the left ninth intercostal artery (ICA9), which is the origin of the artery of Adamkiewicz (arrow), is occluded proximally at the aorta and patent ICA9 and 10th intercostal artery (ICA10) (arrowheads). For clarity, the right intercostals and left 7th, 8th, and 12th intercostal arteries were digitally subtracted. The magnified anterior three-dimensional VR image (Fig 2), which had the aorta digitally removed, reveals collateral circulation (*) from the ICA9 to the 10th intercostal artery (ICA10). The CPR image (Fig 3) clearly shows the entire continuity from the aorta (Ao) to the artery of Adamkiewicz (arrow) through the collateral circulation (*).
Although visualization of the artery of Adamkiewicz with a four-row multislice CT scanner with a 1-mm or 2-mm slice thickness has been reported, none demonstrated the collateral circulation to the artery of Adamkiewicz. We successfully depicted the critical collateral circulation between the intercostal arteries using a 16-row multislice CT scanner with a 0.5-mm slice thickness. Visualization of the small collateral arteries may be achieved through the improved spatial resolution by the thin slice thickness. The preoperative workup using three-dimensional VR and CPR imaging may become a valuable adjunct in revealing critical anatomic details of the artery of Adamkiewicz, including the presence of complex collateral circulation.
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AJNR Am. J. Neuroradiol.,
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29(4):
619 - 631.
[Abstract]
[Full Text]
[PDF]
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