Daisuke Utsunomiya MD, Presenter: Nothing to Disclose

Kazuo Awai MD, Abstract Co-Author: Nothing to Disclose

Yasuyuki Yamashita MD, Abstract Co-Author: Nothing to Disclose

Takashi Sakamoto MD, Abstract Co-Author: Nothing to Disclose

Hiroyuki Hazeyama, Abstract Co-Author: Nothing to Disclose

Joji Urata MD, Abstract Co-Author: Nothing to Disclose

The appropriate contrast injection protocol has remained undefined, although preoperative identification of the Adamkiewicz artery is clinically important. The purpose of our study was to prospectively investigate the contrast agent concentration and the infusion rate to obtain optimal images at computed tomographic (CT) angiography of the Adamkiewicz artery by using 64-row multidetector CT.

Eighty patients were divided into four groups based on the contrast administration protocol: group A, 100 mL of contrast agent (300mgI/mL) at 5.0 mL/s; group B, 100 mL of contrast agent (350mgI/mL) at 5.0 mL/s; group C, 100 mL of contrast agent (300mgI/mL) at 3.5 mL/s; group D, 100 mL of contrast agent (350mgI/mL) at 3.5 mL/s. A 20-mL saline flush was used in all protocols. Four regions of interest (ROIs) were drawn from the distal aortic arch (ROI 1) to the abdominal aorta at L2 level (ROI 4). Quantitative evaluation was performed by calculating mean aortic attenuation value. Visual evaluation of CT angiographic images of the Adamkiewicz artery was also performed.

In quantitative evaluation, the injection rate of 5 mL/sec (group A, 473.4 ± 82.6 HU; group B, 506.7 ± 71.9 HU) was significantly superior to that of 3.5 mL/sec (group C, 371.3 ± 65.1 HU; group D, 391.5 ± 60.8 HU). In visual evaluation, the Adamkiewicz artery was assessable in 15 of 20 (75%), 16 of 20 (80%), 9 of 20 (45%), and 10 of 20 (50%) patients in group A, B, C, and D, respectively. There was a significant positive correlation between the visual evaluation and the quantitative evaluation results.

High contrast concentration administered at high injection rate (1.75 g iodine/sec) provides both highest attenuation value and best visualization of the Adamkiewicz artery for 64-row multidetector CT.

Optimal contrast application at 64-MDCT provides the good visualization of the Adamkiewicz artery and can prevent postoperative neurological deficit in patients with descending aortic aneurysm.

Utsunomiya, D, Awai, K, Yamashita, Y, Sakamoto, T, Hazeyama, H, Urata, J, Demonstration of the Adamkiewicz Artery in Patients with Descending or Thoracoabdominal Aortic Aneurysm: Optimal Contrast Application for 64-Detector Row CT Angiography.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5008487.html