Guziński Maciej, Bryl Maciej, Ziemińska Katarzyna, Wolny Kamila, Sąsiadek Marek, Garcarek Jerzy S
Department of General and Interventional Radiology and Neuroradiology, Wroclaw Medical University, Poland.
Department of Neurosurgery, Barlicki University Hospital, Łódź, Poland.
Adv Clin Exp Med. 2017 Jan-Feb;26(1):31-37. doi: 10.17219/acem/62788.
The great anterior radiculomedullary artery, also known as the artery of Adamkiewicz (AKA), is a small-caliber vessel which arises from the intercostal or lumbar arteries branching out from the aorta.
The aim of this study was to evaluate detection of the AKA, as well as its level and side of origin, with multi-slice contrast enhanced computed tomography (MSCT) of the abdomen and thorax performed during everyday clinical practice, and to compare the results with the literature.
The study retrospectively evaluated 200 consecutive MSCT images of the thoracic and thoracoabdominal aorta performed at Wroclaw Medical University's Department of General and Interventional Radiology and Neuroradiology as part of normal clinical work-ups. The CT examinations were performed with a 64-slice CT scanner. Arterial-phase images were analyzed for detection of the AKA and for anatomical variants of the AKA.
Recognition of the AKA was achieved in 43 of 200 patients (21.5%). Out of these 43 cases, the AKA originated on the left side in 36 instances (83.7%) - a significantly higher number than on the right side (only in 6 cases, 14%); in one case (2.3%) it arose from both sides (p < 0.05, T-test). Most of the AKAs (24 cases, 55.8%) originated on the left side at level T11 or T12. In 13 patients (30.2%) the AKA arose from T11 or from T12 intercostal arteries. The origin of the AKA varied greatly and ranged from T5 (2.3%) to L2 (2.3%).
The AKA is characterized by left-side lateralization and is associated with a wide range of origin, from T5 to L2. Detection of the AKA is, relatively speaking, rarely possible in routine clinical CT in the arterial phase - only in 1/5 of the patients. Therefore it is necessary to perform dedicated, individual arterial phase bolus tracking enhancement CT scans from the T5 to L3 level.
大前根髓动脉，也称为Adamkiewicz动脉（AKA），是一条小口径血管，起源于从主动脉分支出来的肋间动脉或腰动脉。
本研究的目的是评估在日常临床实践中通过腹部和胸部多层对比增强计算机断层扫描（MSCT）检测AKA及其起源水平和侧别，并将结果与文献进行比较。
本研究回顾性评估了弗罗茨瓦夫医科大学普通与介入放射学及神经放射学系作为正常临床检查一部分所进行的200例连续的胸主动脉和胸腹主动脉MSCT图像。CT检查使用64层CT扫描仪进行。分析动脉期图像以检测AKA及其解剖变异。
200例患者中有43例（21.5%）识别出了AKA。在这43例中，AKA起源于左侧的有36例（83.7%）——显著多于右侧（仅6例，14%）；1例（2.3%）双侧起源（p < 0.05，t检验）。大多数AKA（24例，55.8%）起源于左侧的T11或T12水平。13例患者（30.2%）的AKA起源于T11或T12肋间动脉。AKA的起源差异很大，范围从T5（2.3%）到L2（2.3%）。
AKA的特点是左侧优势，且起源范围广泛，从T5到L2。相对而言，在常规临床CT动脉期很少能检测到AKA——仅在五分之一的患者中。因此，有必要从T5到L3水平进行专门的、个体化的动脉期团注追踪增强CT扫描。
