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MDCT Angiography of the Spinal Vasculature and the Artery of Adamkiewicz

Daniel T. Boll1,2, Hubertus Bulow2, Kristine A. Blackham1, Andrik J. Aschoff2 and Bernd L. Schmitz2

1 Department of Radiology, University Hospitals of Cleveland, 11100 Euclid Ave., Cleveland, OH 44106.
2 Department of Radiology, University Hospital of Ulm, Ulm, Germany.


Figure 1
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  		Fig. 1A —Course of artery of Adamkiewicz (red) and its feeding arteries. Schematic drawing (A) and curved multiplanar reformation (B) at 10th vertebral level show course of artery of Adamkiewicz (red) and its feeding arteries in 42-year-old man. Originating from thoracic aorta (1), intercostal artery (2) subdivides into anterior (3) and posterior (4) branches. Posterior branch courses to spine and enters vertebral foramen (asterisk, B) as radiculomedullary artery (5). Artery of Adamkiewicz is most dominant anterior branch of radiculomedullary arteries. Distal portion of artery of Adamkiewicz (6) and anterior spinal artery (7) form characteristic hairpin turn (ampersand, B).

 

Figure 2
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  		Fig. 1B —Course of artery of Adamkiewicz (red) and its feeding arteries. Schematic drawing (A) and curved multiplanar reformation (B) at 10th vertebral level show course of artery of Adamkiewicz (red) and its feeding arteries in 42-year-old man. Originating from thoracic aorta (1), intercostal artery (2) subdivides into anterior (3) and posterior (4) branches. Posterior branch courses to spine and enters vertebral foramen (asterisk, B) as radiculomedullary artery (5). Artery of Adamkiewicz is most dominant anterior branch of radiculomedullary arteries. Distal portion of artery of Adamkiewicz (6) and anterior spinal artery (7) form characteristic hairpin turn (ampersand, B).

 

Figure 3
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  		Fig. 2 —Schematic double oblique multiplanar reformation at coronal level of spinal cord in 36-year-old woman shows course of artery of Adamkiewicz and its feeding arteries with locations of diametric and contrast-to-noise evaluations (1). All evaluated posterior branches of feeding and neighboring segments were evaluated 5 mm distal to vascular bifurcation of intercostal or lumbar artery (2). Radiculomedullary artery was uniformly evaluated while passing through neuroforamen; great anterior radiculomedullary artery was assessed in a base segment (3) characterized by horizontal orientation of vascular cross section and in a hairpin segment (4) delineated by a vertical vascular cross section. Measurements in anterior spinal artery were performed 5 mm below hairpin junction (5).

 

Figure 4
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  		Fig. 3 —Bar graph shows distribution of originating segments of artery of Adamkiewicz throughout thoracic and lumbar segments. Bell-shaped curve represents gaussian normal distribution.

 

Figure 5
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  		Fig. 4 —Double oblique multiplanar reformation at coronal level of anterior spinal cord shows artery of Adamkiewicz in 75-year-old man. Entire length from hairpin turn (asterisk) to neuroforamen is 98.2 mm, spanning three vertebral segments.

 

Figure 6
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  		Fig. 5 —Double oblique multiplanar reformation of schematic at coronal level of anterior spinal cord in 68-year-old man shows hairpin turn (asterisk) and course (large arrow) of artery of Adamkiewicz, posterior branches of intercostal arteries at feeding segment (circle), and ipsilateral and contralateral segments (arrowheads) with branching radiculomedullary arteries (small arrows). Note significantly wider lumen of posterior branch at feeding vertebral segment (circle) in contrast to adjacent segments (arrowheads).

 

Figure 7
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  		Fig. 6 —Double oblique multiplanar reformation at coronal level of anterior spinal cord shows ipsilateral duplication of artery of Adamkiewicz (asterisks) in 66-year-old woman. Duplicate arteries of Adamkiewicz originate from same segmental radiculomedullary artery (arrow). Proximal sections of artery of Adamkiewicz are located in different vertical planes, thereby forming a continuous vessel tract that can be visualized for only one artery.

 

Figure 8
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  		Fig. 7 —Double oblique multiplanar reformation at coronal level of anterior spinal cord shows ipsilateral duplication of artery of Adamkiewicz (asterisks) in 55-year-old woman. Duplicate arteries originate from adjacent segmental radiculomedullary artery (arrows).

 

Figure 9
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  		Fig. 8 —Double oblique multiplanar reformation at coronal level of anterior spinal cord show bilateral duplication of artery of Adamkiewicz (asterisks) in 59-year-old man. Duplicate arteries originate from distant segmental radiculomedullary artery (arrows).

 

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