ISSN: 1899-0967
Polish Journal of Radiology
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1/2020
vol. 85
 
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Interventional radiology
abstract:
Original paper

Detection of the artery of Adamkiewicz using multidetector row computed tomography in patients with spinal arteriovenous shunt disease

Sodai Hoshiai
1
,
Masanari Shiigai
2
,
Takahiro Konishi
2
,
Yasunobu Nakai
3
,
Tomohiko Masumoto
1

1.
Department of Radiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
2.
Department of Radiology, Tsukuba Medical Centre Hospital, Tsukuba, Ibaraki, Japan
3.
Intravascular Treatment Centre, Yokohama Brain and Spine Centre, Isogo-ku, Yokohama, Japan
© Pol J Radiol 2020; 85: e163-e168
Online publish date: 2020/03/19
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Purpose
To plan a treatment strategy for a spinal arteriovenous shunt (SAVS), identifying the artery of Adamkiewicz (AKA) and its origin is indispensable. However, detecting the AKA is very difficult in patients with an SAVS when using computed tomography angiography (CTA) by the usual method to find the hairpin curved artery because dilated drainage veins nearly always coexist with the hairpin curved AKA. We designed a method to identify the AKA by focusing on the diameter and pathway of the anterior radiculomedullary arteries (RMAs).

Material and methods
Seven consecutive patients with an SAVS were surveyed. They underwent contrast-enhanced CTA and conventional angiography from January 2009 to December 2012. Two readers evaluated the CTA images and assumed that the AKA was the artery that ran through the anterior portion of the neural foramen and continued to pass on the ventral side of the spinal cord.

Results
Among the seven patients, nine AKAs were detected with conventional angiography. When using our method, seven AKAs and six AKAs were identified on CTA by Reader 1 and Reader 2, respectively. The average sensitivity was 72.3%, and the specificity, accuracy, positive predictive value, and negative predictive value were sufficiently high (i.e. > 85%) for both readers. The kappa value for detecting the AKA was 0.98.

Conclusions
Detecting the origin of the AKA with CTA is challenging in patients with an SAVS. However, focusing on the diameter and pathway of the RMAs may allow successful identification.

keywords:

artery of Adamkiewicz, multidetector computed tomography, computed tomography, computed tomography angiography, spinal arteriovenous shunt, arteriovenous fistula

 
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