title: Spinal intraarterial computed tomography angiography as an effective adjunct for spinal angiography.
abstract: OBJECTIVE
  Spinal digital subtraction angiography (DSA) is indispensable for the precise diagnosis of spinal vascular lesions and the assessment of blood supply to the spinal cord. However, comprehensive spinal DSA covering multiple segments requires repetition of selective catheterization into small segmental arteries, which is time consuming, sometimes difficult, and hazardous. The authors investigated the usefulness of CT angiography with intraarterial contrast injection (IA-CTA) as a preliminary study preceding spinal DSA. With the advent of multidetector CT, it is feasible to obtain images of the spinal cord vasculature instantaneously overa number of segments.
  
  
  METHODS
  A total of 56 patients with lesions involving the spinal vasculature underwent IA-CTA with 64- or 320-row detector CT in advance of comprehensive spinal DSA. Contrast material was injected via a pigtail catheter placed at the aorta in proximity to the segments of interest. Scanning was repeated twice to obtain arterial- and venous-phase images to differentiate between the arterial and venous components. The spinal arteries were identified by paging the various multiplanar reconstruction images and tracing the vessels from the aorta. Spinal DSA was subsequently performed by guiding selective catheterization to the feeding segments in reference to the IA-CTA findings. Visualization of the segmental arteries, normal spinal arteries, and abnormal vessels during IA-CTA was investigated and compared with that obtained during spinal DSA.
  
  
  RESULTS
  In all 56 patients, spinal IA-CTA successfully enabled visualization of the spinal vessels, including the radicular arteries and the anterior spinal artery. Below the aortic arch, all segmental arteries were identified clearly. The segmental arteries, radiculomedullary arteries, spinal arteries, and abnormal vessels were traced from the aorta, which would be the target of selective catheterization. In 3 (6.8%) patients, IA-CTA revealed severe aortic atherosclerosis and occlusion of some segmental arteries. The information obtained was useful for directing selective catheterization studies. The findings of IA-CTA corresponded well with those of spinal DSA.
  
  
  CONCLUSIONS
  IA-CTA is a useful adjunct to spinal DSA for surveying the vasculature surrounding the spinal cord and for orienting selective catheterization. IA-CTA can complement spinal DSA, curtail unnecessary segmental injections, and thus reduce procedural complications.
authors.affiliation: Department of Neurosurgery, Dokkyo University School of Medicine, Tochigi, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Yamamoto
authors.affiliation: Department of Neurosurgery, Dokkyo University School of Medicine, Tochigi, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Kanaya
authors.affiliation: Department of Neurosurgery, Dokkyo University School of Medicine, Tochigi, Japan.
authors.forename: Phyo
authors.initials: P
authors.lastname: Kim
mesh_terms: D000328:Adult; D015901:Angiography, Digital Subtraction / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013131:Spine / Q000098:blood supply* / Q000000981:diagnostic imaging*
keywords: CT angiography; CTA = CT angiography; DSA = digital subtraction angiography; IA-CTA = CTA with intraarterial contrast injection; IV-CTA = CTA with intravenous contrast injection; intraarterial; spinal angiography; spinal arteriovenous fistula; spinal arteriovenous malformation; technique