Amato Alexandre Campos Moraes, Parga Filho Jose Rodrigues, Stolf Noedir Antonio Groppo
Post-Graduate Program, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Cardiovascular Magnetic Resonance and Computed Tomography Sector, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
SAGE Open Med. 2017 Jun 2;5:2050312117711599. doi: 10.1177/2050312117711599. eCollection 2017.
The detection of the Adamkiewicz artery and the anterior spinal artery has been associated with the ability to prevent adverse spinal cord outcomes after aortic surgical procedures. Yet, to our knowledge, no previous studies have attempted to use modern predictive models to identify the most important variables in determining artery detectability.
To develop a model to predict the odds of visualizing the Adamkiewicz artery or anterior spinal artery in patients undergoing computerized tomographic angiography.
We conducted a prospective, cross-sectional study. Outcomes of interest were the non-detection of the Adamkiewicz artery and anterior spinal artery, and their corresponding level of origin. Axial images were inspected in high definition in search of two dense spots characterizing the Adamkiewicz artery and anterior spinal artery. A multiplanar three-dimensional reconstruction was then performed using the OsiriX® software.
A total of 110 participants were part of this analysis. When evaluating risks for the Adamkiewicz artery being undetectable, significant factors could be classified into three broad categories: risk factors for arterial disease, established arterial disease, and obesity. Factors in the former category included metabolic syndrome, hypertension, and smoking status, while factors in the arterial disease included descending aortic aneurysm, mural thrombi, aortic aneurysm without a dissection, and aortic disease in general. In relation to anterior spinal artery not being detectable, significant risk factors included hypertension, smoking status, and metabolic syndrome, while those associated with arterial disease involved aortic disease and arterial thrombi. When evaluating the importance of individual clinical factors, the presence of higher body mass index was the single most important risk factor.
Arterial disease, established arterial disease, and increased body mass index are risk factors in the detection of Adamkiewicz artery and anterior spinal artery. Specific diagnostic protocols should be in place for patients with these underlying conditions, thus enhancing the likelihood of detection when the Adamkiewicz artery is indeed present.
识别Adamkiewicz动脉和脊髓前动脉与预防主动脉手术后不良脊髓预后的能力相关。然而，据我们所知，此前尚无研究尝试使用现代预测模型来确定影响动脉可检测性的最重要变量。
建立一个模型，用于预测接受计算机断层血管造影的患者中可视化Adamkiewicz动脉或脊髓前动脉的概率。
我们进行了一项前瞻性横断面研究。感兴趣的结果是未检测到Adamkiewicz动脉和脊髓前动脉及其相应的起源水平。以高分辨率检查轴向图像，寻找表征Adamkiewicz动脉和脊髓前动脉的两个密集斑点。然后使用OsiriX®软件进行多平面三维重建。
共有110名参与者纳入本分析。在评估Adamkiewicz动脉不可检测性的风险时，显著因素可分为三大类：动脉疾病危险因素、已确诊的动脉疾病和肥胖。前一类因素包括代谢综合征、高血压和吸烟状况，而动脉疾病因素包括降主动脉瘤、壁血栓、无夹层的主动脉瘤以及一般的主动脉疾病。关于脊髓前动脉不可检测，显著危险因素包括高血压、吸烟状况和代谢综合征，而与动脉疾病相关的因素包括主动脉疾病和动脉血栓。在评估个体临床因素的重要性时，较高的体重指数是唯一最重要的危险因素。
动脉疾病、已确诊的动脉疾病和体重指数增加是检测Adamkiewicz动脉和脊髓前动脉的危险因素。对于有这些基础疾病的患者应制定特定的诊断方案，从而在Adamkiewicz动脉确实存在时提高检测的可能性。
