Yoshioka Kunihiro, Niinuma Hiroyuki, Ehara Shigeru, Nakajima Takayuki, Nakamura Motoyuki, Kawazoe Kohei
Department of Radiology, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate 020-8505, Japan.
Radiographics. 2006 Oct;26 Suppl 1:S63-73. doi: 10.1148/rg.26si065506.
It is very important to assess the artery of Adamkiewicz before repair of the thoracoabdominal or descending thoracic aorta. Several studies have demonstrated the feasibility and advantages of noninvasive assessment of the artery of Adamkiewicz with magnetic resonance (MR) angiography and multi-detector row computed tomographic (CT) angiography. Recent advances in MR angiography and CT angiography have led to changes in the detectability of this artery. In the present study, both MR angiography and CT angiography were performed without complications for preoperative evaluation of 30 patients who underwent repair of the thoracoabdominal or descending thoracic aorta. MR angiography provided detection rates as high as 93% and 80% with the morphologic "hairpin turn" criterion and the anatomic "continuity" criterion, respectively. Sixteen-detector row CT angiography provided detection rates as high as 83% and 60%, respectively. Use of both MR angiography and CT angiography provided higher detection rates of 97% and 90%, respectively. The collateral pathways were depicted in seven cases (23%). MR angiography is superior for depiction of the artery of Adamkiewicz, especially when it arises from the false lumen of a dissecting aneurysm. CT angiography has a wide field of view and allows depiction of significant collateral pathways associated with the internal thoracic artery and intercostal arteries.
在修复胸腹主动脉或胸降主动脉之前，评估Adamkiewicz动脉非常重要。多项研究已证明，利用磁共振（MR）血管造影和多排螺旋计算机断层扫描（CT）血管造影对Adamkiewicz动脉进行无创评估的可行性和优势。MR血管造影和CT血管造影的最新进展已导致该动脉可检测性的变化。在本研究中，对30例行胸腹主动脉或胸降主动脉修复术的患者进行术前评估时，MR血管造影和CT血管造影均顺利完成，未出现并发症。MR血管造影根据形态学“发夹弯”标准和解剖学“连续性”标准得出的检出率分别高达93%和80%。16排CT血管造影的检出率分别高达83%和60%。同时使用MR血管造影和CT血管造影的检出率更高，分别为97%和90%。7例（23%）显示了侧支循环途径。MR血管造影在显示Adamkiewicz动脉方面更具优势，尤其是当它起源于夹层动脉瘤的假腔时。CT血管造影视野广阔，能够显示与胸廓内动脉和肋间动脉相关的重要侧支循环途径。
