Usefulness of preoperative detection of artery of Adamkiewicz with dynamic contrast-enhanced MR angiography.
OBJECTIVE
To prospectively evaluate the detection of the artery of Adamkiewicz at magnetic resonance (MR) angiography and the effect such detection has on outcome after surgical graft placement in a series of patients with thoracoabdominal aortic disease.


METHODS
This study had ethics committee approval, and written informed consent was obtained from all patients. Fifty patients (38 men, 12 women; age range, 47-83 years; mean age, 67.2 years) who were scheduled to undergo thoracoabdominal aortic surgery for treatment of thoracoabdominal aortic aneurysm (n = 42) or thoracoabdominal aortic dissection (n = 8) were enrolled in the study. MR angiography was performed with a 1.5-T system by using dynamic three-dimensional fast spoiled gradient-recalled acquisition in the steady state with a bolus of contrast material and saline injection (4 mL/sec). Differences in the cross-clamping time, bypass time, total surgery time, and spinal complication rate between patients in whom the artery of Adamkiewicz was identified (group A) and those in whom the artery was not identified (group B) were evaluated with chi(2) or Mann-Whitney U testing.


RESULTS
In 42 of the 50 patients (84% [group A]), at least one artery of Adamkiewicz was seen to arise from an intercostal artery. Two arteries of Adamkiewicz were identified in four of the patients (8%). The artery of Adamkiewicz could not be detected with MR angiography in eight patients (group B). The ranges of cross-clamping, bypass, and total surgery times, respectively, were 30-199 minutes (mean, 78.4 minutes +/- 39.1 [standard deviation]), 30-298 minutes (mean, 96.9 minutes +/- 60.0), and 135-665 minutes (mean, 354.9 minutes +/- 133.9) in group A and 53-124 minutes (mean, 72.8 minutes +/- 29.8), 10-124 minutes (mean, 66.0 minutes +/- 41.0), and 220-405 minutes (mean, 315.6 minutes +/- 68.8) in group B. Spinal complications occurred in two patients in group B but in none of the patients in group A (P < .001).


CONCLUSIONS
The artery of Adamkiewicz was detected in a large percentage of patients in whom there were no spinal complications, unlike the spinal complications that occurred in the patients in whom the artery was not detected.
Hyodoh
Hideki
H
Department of Radiology, Sapporo Medical University, S-1 W-16 Chuo-ku, Sapporo 060-8543, Japan. hyodoh@sapmed.ac.jp
Kawaharada
Nobuyoshi
N
Akiba
Hidenari
H
Tamakawa
Mitsuharu
M
Hyodoh
Kazusa
K
Fukada
Johji
J
Morishita
Kiyofumi
K
Hareyama
Masato
M
D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001158:Arteries; D019917:Blood Vessel Prosthesis Implantation; D016009:Chi-Square Distribution; D003287:Contrast Media; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013116:Spinal Cord / Q000098:blood supply*; D020760:Spinal Cord Ischemia / Q000517:prevention & control; D018709:Statistics, Nonparametric
D003287:Contrast Media