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To improve our ability to visualize the Adamkiewicz artery (AKA), we developed a modified intravenous CT angiography technique, which we refer to as right atrial CT (RA-CT) angiography. In this study, AKA detection rate and visualization of the arterial continuity from the aorta to the anterior spinal cord artery (ASA) was evaluated using RA-CT angiography.We performed RA-CT angiography in 110 patients with abdominal, thoracic descending, or thoracoabdominal aortic aneurysms. In RA-CT angiography, contrast medium with a high iodine concentration (370 mg/dl) was injected twice into the right atrium at a high injection rate (8.0 ml/sec), and two CT scans, starting at 20 sec after the first injection and at 35 sec after the second injection, respectively, were performed. All CT images were obtained using an 8- or 16-detector CT scanner at a slice thickness of 0.625 mm. The AKA was defined as the largest radiculomedullary artery with a characteristic hairpin turn, and with continuity from the aorta to the ASA.The AKA with hairpin turn was detected in all patients (100%), and continuity from the aorta to the ASA was confirmed in 99 of the 110 patients (90.0%). The AKA arose between Th8 and L1 in 86 of these patients (86.8%), and originated from the left side in 71 patients (71.7%).RA-CT angiography may be useful for visualizing the AKA and the arterial continuity from the aorta to the ASA in patients with aortic aneurysm, although the use of more advanced CT machines will provide safe and easy identification of the AKA and arterial continuity with a small amount of contrast medium and a single scan.

Preoperative Visualization of the Artery of Adamkiewicz by Dual-Phase CT Angiography in Patients with Aortic Aneurysm