Higuchi Akio, Kubota Yoshihiro, Yokota Hajime, Miyazaki Hiroki, Ota Joji, Okafuji Yasuaki, Takaoka Hiroyuki, Uno Takashi
Department of Radiology, Chiba University Hospital, Chiba, Japan.
Department of Diagnostic Radiology and Radiation Oncology, Chiba University Graduate School of Medicine, Chiba, Japan.
Neuroradiology. 2024 Dec;66(12):2215-2221. doi: 10.1007/s00234-024-03433-9. Epub 2024 Aug 5.
Identification of the Adamkiewicz artery before aortic surgery is important for preventing postoperative complications due to spinal cord ischemia. The Adamkiewicz artery is difficult to identify due to its small diameter. Nitroglycerin has a vasodilatory effect and is used clinically to improve visualization of blood vessels on coronary computed tomography (CT) angiography. We investigated whether the vasodilatory effect of nitroglycerin could improve the ability to visualize the Adamkiewicz artery.
We extracted 33 cases wherein contrast-enhanced CT images were taken before and after aortic aneurysm surgery. Nitroglycerin was administered for coronary artery evaluation on the preoperative CT. However, no nitroglycerin was administered before the postoperative CT. Aortic contrast-to-noise ratio, CT value, image noise, and diameter of the Adamkiewicz artery and anterior spinal artery were measured. The depiction of the Adamkiewicz artery was graded into four grades and evaluated. These measurements were performed by two independent reviewers.
In nitroglycerin-administered cases, the contrast-to-noise ratio and CT values were significantly higher (P < 0.001, P < 0.001, respectively); the Adamkiewicz artery and anterior spinal artery diameters were dilated (P = 0.005, P = 0.001, respectively). The Adamkiewicz artery score also improved significantly (P < 0.001). No significant difference was found in image noise.
Nitroglycerin contributed to improving the Adamkiewicz artery's visualization.
在主动脉手术前识别Adamkiewicz动脉对于预防脊髓缺血引起的术后并发症很重要。Adamkiewicz动脉因其直径小而难以识别。硝酸甘油具有血管舒张作用，临床上用于改善冠状动脉计算机断层扫描（CT）血管造影上血管的可视化。我们研究了硝酸甘油的血管舒张作用是否能提高Adamkiewicz动脉的可视化能力。
我们提取了33例主动脉瘤手术前后进行对比增强CT成像的病例。术前CT用于冠状动脉评估时给予硝酸甘油。然而，术后CT前未给予硝酸甘油。测量Adamkiewicz动脉和脊髓前动脉的主动脉对比噪声比、CT值、图像噪声和直径。Adamkiewicz动脉的显示分为四个等级并进行评估。这些测量由两名独立的审阅者进行。
在给予硝酸甘油的病例中，对比噪声比和CT值显著更高（分别为P < 0.001，P < 0.001）；Adamkiewicz动脉和脊髓前动脉直径扩张（分别为P = 0.005，P = 0.001）。Adamkiewicz动脉评分也显著提高（P < 0.001）。图像噪声未发现显著差异。
硝酸甘油有助于改善Adamkiewicz动脉的可视化。
