IMAGES IN CARDIOTHORACIC SURGERY

Three-Dimensional Demonstration of the Collateral

Circulation to the Artery of Adamkiewicz With
16-Row Multislice Computed Tomography
Kunihiro Yoshioka, MD, Hiroyuki Niinuma, MD, Yoshinobu Ogino, MD,
Kenta Muranaka, RT, Kohei Kawazoe, MD, and Shigeru Ehara, MD
Departments of Radiology and Cardiovascular Surgery, Memorial Heart Center, and Department of Internal Medicine II, Iwate
Medical University, Iwate, Japan

FEATURE ARTICLES
Fig 2.

Fig 1.

A 74-year-old man who had a previous repair of an

infrarenal abdominal aortic aneurysm was scheduled
to undergo the repair of a 6.5-cm thoracic aortic aneurysm.
For preoperative assessment, a three-dimensional com-
puted tomographic (CT) angiogram was obtained using a
16-row multislice CT scanner (Aquilion 16, Toshiba, Tokyo,
Japan). The scan was performed from the seventh thoracic
vertebra to the second lumbar vertebra with a slice thick-
ness of 0.5 mm after the injection of low-osmolarity contrast
medium into the right antecubital vein.
Three-dimensional volume rendering (VR) images and
curved planar reformatted (CPR) images were obtained on
a workstation (ZIO M900, Ziosoft, Tokyo, Japan). The left
anterior oblique three-dimensional VR image (Fig 1), with
semitransparent skeletal system and aorta, shows that the
left ninth intercostal artery (ICA9), which is the origin of the
artery of Adamkiewicz (arrow), is occluded proximally at the
aorta and patent ICA9 and 10th intercostal artery (ICA10)
(arrowheads). For clarity, the right intercostals and left 7th,
8th, and 12th intercostal arteries were digitally subtracted.
The magnified anterior three-dimensional VR image (Fig 2),
Address correspondence to Dr Yoshioka, Department of Radiology,
Memorial Heart Center, Iwate Medical University, 19-1, Uchimaru,
Morioka, Iwate, 020-8505, Japan; e-mail: kyoshi@iwate-med.ac.jp.
Fig 3.
which had the aorta digitally removed, reveals collateral
circulation (*) from the ICA9 to the 10th intercostal artery
(ICA10). The CPR image (Fig 3) clearly shows the entire
continuity from the aorta (Ao) to the artery of Adamkiewicz
(arrow) through the collateral circulation (*).
Although visualization of the artery of Adamkiewicz with
a four-row multislice CT scanner with a 1-mm or 2-mm
slice thickness has been reported, none demonstrated the
collateral circulation to the artery of Adamkiewicz. We
successfully depicted the critical collateral circulation be-
tween the intercostal arteries using a 16-row multislice CT
scanner with a 0.5-mm slice thickness. Visualization of the
small collateral arteries may be achieved through the im-
proved spatial resolution by the thin slice thickness. The
preoperative workup using three-dimensional VR and CPR
imaging may become a valuable adjunct in revealing critical
anatomic details of the artery of Adamkiewicz, including
the presence of complex collateral circulation.

2006 by The Society of Thoracic Surgeons Ann Thorac Surg 2006;81:749 0003-4975/06/$32.00
Published by Elsevier Inc doi:10.1016/j.athoracsur.2004.01.039