Article Figures & Data
Figures
- Fig 1.
Postmortem spinal cord specimen of the anterior cord surface, on which both the superficial spinal cord arteries and veins are shown. The great anterior radiculomedullary artery (ie, the Adamkiewicz artery [AKA]) (white arrow) and anterior spinal artery (ASA) (white arrowheads) are displayed on the right side of the image. The anterior median vein (AMV) (black arrowheads) as well as the great anterior radiculomedullary vein (GARV) (black arrow) are displayed on the left side. Note the close anatomic relation between the AMV and ASA as well as the similarity in the configuration of the AKA and GARV, respectively. Clotted blood is present in the veins and ASA. No blood is present in the AKA (white appearance) because of the preparation process. (Used with permission.)
- Fig 2.
Coronal digital subtraction angiography (DSA) projection (A) and multiplanar reformatted contrast-enhanced MR angiography (CE-MRA) of the early phase (B) and late phase (C) in a 57-year-old male patient (case 3) with a spinal arteriovenous malformation (diagnosed on the basis of DSA). On the DSA projection image (A), the supplying segmental artery (SA) (asterisk), the great anterior radiculomedullary artery, (ie, the Adamkiewicz artery [AKA]) (large white arrow), and the anterior spinal artery (ASA) (white arrowheads) are shown. The CE-MRA of the early phase (B) shows the supplying SA (asterisk) and the AKA (large white arrow). Regarding the anterior midline enhancement in the early phase (B) above as well as below the connection of the AKA with the ASA, this is most likely to be enhancement of both the ASA (white arrowheads) and the anterior median vein (AMV) (black arrowheads). The late phase CE-MRA (C) shows diminished signal intensity of the AKA (large white arrow), in contrast to the anterior midline enhancement, which is clearly increased compared with the early phase (B) because of increased venous enhancement. The midline enhancement seen in the late phase (C) is most likely to be a combination of AMV (black arrowheads) and ASA (white arrowheads) enhancement. Furthermore, there is enhancement of the venous plexus (small black arrows) in the late phase (C) that is not seen in the early-phase CE-MRA image (B). Note that the cephalad enhancement above the connection of the AKA with the ASA is depicted only in the CE-MRA images (B and C), and not in the DSA image (A). Note also that the AKA appears enlarged in the DSA as well as the CE-MRA examination.
- Fig 3.
Coronal digital subtraction angiography (DSA) projection (A) and multiplanar reformatted contrast-enhanced MR angiography (CE-MRA) of the early phase (B) and late phase (C and D) in a 43-year-old female patient (case 12) with no spinal arteriovenous malformations. On the DSA projection image (A), the supplying segmental artery (SA) (asterisk), the great anterior radiculomedullary artery (ie, the Adamkiewicz artery [AKA]) (large white arrow), and the anterior spinal artery (ASA) (white arrowhead) are shown. The CE-MRA of the early phase (B) shows the supplying SA (asterisk) and the AKA (large white arrow). Regarding the anterior midline enhancement in the early phase (B) above as well as below the connection of the AKA with the ASA, this is most likely to be the combined enhancement of the ASA (white arrowheads) as well as the anterior median vein (AMV) (black arrowheads). The late phase CE-MRA (C) shows diminished signal intensity of the AKA (large white arrowhead) in contrast to the anterior midline enhancement, which is clearly increased compared with the early phase (B) because of increased venous enhancement. The midline enhancement seen in the late phase (C and D) is most likely to be a combination of AMV (black arrowheads) and ASA (white arrowheads) enhancement. In addition, the great anterior radiculomedullary vein (GARV) (large black arrow) is displayed in the late phase of the CE-MRA (D). Note that the signal intensity of the GARV and midline enhancement is equal (D). Furthermore, there is enhancement of the venous plexus (small black arrows) in the late phase (C and D) that is not seen in the early-phase CE-MRA image (B). Furthermore, note that the cephalad enhancement above the connection of the AKA with the ASA is depicted only in the CE-MRA images (B and C), and not in the DSA image (A).
- Fig 4.
Coronal digital subtraction angiography (DSA) projection (A) and multiplanar reformatted contrast-enhanced MR angiography (CE-MRA) of the early phase (B) and late phase (C and D) in a 55-year-old male patient (case 8) with a spinal dural arteriovenous fistula (diagnosed on the basis of DSA). On the DSA projection image (A) the supplying segmental artery (SA) (asterisk), the great anterior radiculomedullary artery (ie, the Adamkiewicz artery [AKA]) (large white arrow), and the anterior spinal artery (ASA) (white arrowhead) are shown. The CE-MRA of the early phase (B) shows the supplying SA (asterisk) and the AKA (large white arrow). Regarding the anterior midline enhancement in the early phase (B) above as well as below the connection of the AKA with the ASA, this is most likely to be enhancement of both the ASA (white arrowheads) and the anterior median vein (AMV) (black arrowheads). The late-phase CE-MRA (C) shows diminished signal intensity of the AKA (large white arrow), in contrast to the anterior midline enhancement, which is clearly increased compared with the early phase (B) as a result of increased venous enhancement. The midline enhancement seen in the late phase (C and D) is most likely to be a combination of AMV (black arrowheads) and ASA (white arrowheads) enhancement. In addition, the great anterior radiculomedullary vein (GARV) (large black arrow) is displayed in the late phase of the CE-MRA (D). Note that the signal intensity of the GARV and midline enhancement is equal (D). Furthermore, there is enhancement of the venous plexus (small black arrows) in the late phase (C and D), which is not seen in the early phase CE-MRA image (B). Note that the cephalad enhancement above the connection of the AKA with the ASA is only depicted on the CE-MRA images (B and C), and not in the DSA image (A). Note that there is more background enhancement in the CE-MRA images.
- Fig 5.
Coronal digital subtraction angiography (DSA) projection (A) and multiplanar reformatted contrast-enhanced MR angiography (CE-MRA) of the early phase (B) and late phase (C and D) in a 73-year-old male patient (case 13) with a spinal dural arteriovenous fistula (diagnosed on the basis of DSA). On the DSA projection image (A) the supplying segmental artery (SA) (asterisk), the great anterior radiculomedullary artery (ie, the Adamkiewicz artery [AKA]) (large arrow), and the anterior spinal artery (ASA) are shown. The CE-MRA of the early phase (B) shows the supplying SA (asterisk) and the AKA (large white arrow). Regarding the anterior midline enhancement in the early phase (B) above as well as below the connection of the AKA with the ASA, this is most likely to be enhancement of both the ASA (white arrowheads) as well as the anterior median vein (AMV) (black arrowheads). The late phase CE-MRA (C) shows diminished signal intensity of the AKA (large white arrow), in contrast to the anterior midline enhancement, which is clearly increased compared with the early phase (B) as a result of increased venous enhancement. The midline enhancement in the late phase (C) below the connection of the AKA with the ASA is most likely to be a combination of AMV (black arrowheads) and ASA (white arrowheads) enhancement. In addition, the great anterior radiculomedullary vein (GARV) (large black arrow) is displayed in the late phase of the CE-MRA (D). Furthermore, there is enhancement of the venous plexus (small black arrows) in the late phase, which is not seen in the early-phase CE-MRA image (B). Note that the cephalad enhancement above the connection of the AKA with the ASA is depicted only in the late phase CE-MRA (C) and is therefore most likely to correspond to enhancement of the AMV (black arrowhead) only.
- Fig 6.
Coronal digital subtraction angiography (DSA) projection (A) and multiplanar reformatted contrast-enhanced MR angiography (CE-MRA) of the early phase (B and C) and late phase (D) of a 43-year-old female patient (case 11) with a perimedullary arteriovenous malformation of the fistulous type (diagnosed on the basis of DSA). On the DSA projection image (A), the supplying segmental artery (SA) (asterisk), the great anterior radiculomedullary artery (ie, the Adamkiewicz artery [AKA]) (large white arrow), and the anterior spinal artery (ASA) (white arrowheads) are shown. The SA (asterisk) connecting to the AKA (large arrow) is falsely identified in the early phase CE-MRA (B) because of an erroneously created curved multiplanar reformation resulting from the many entangled vessels. Retrospectively, the correct SA (asterisk) supplying the AKA (large white arrows) was identified in the early-phase CE-MRA (C). The cephalad enhancement above the connection of the AKA (large white arrows) with the ASA is depicted only in the late phase CE-MRA image (D), and therefore is most likely to represent the anterior median vein (black arrowhead). In addition, there is enhancement of the venous plexus (small black arrows) in the late-phase CE-MRA image (D) that is not seen in the early phase CE-MRA image (B and C). Note the strong enhancement of the dilated and arterialized veins on the CE-MRA images, which is due to the nonselective manner of contrast administration. Furthermore, the AKA appears enlarged in the DSA as well as the CE-MRA examination.
Tables
- Table 1:
Patient characteristics and observations for contrast-enhanced magnetic resonance angiography and digital subtraction angiography
Patient No./Sex/Age (y) CE-MRA DSA Pathology AKA Other GARV AKA Other GARV Level Side ARA Level Side Level Side ARA 1/M/44 T9 Right No L2 Right T9 Right T4 No Hemangioblastoma 2/M/62 T8 Left No L3 Right T8 Left No No SDAVF 3/M/57 L1 Right No No No L1 Right No No SAVM, fistulous type 4/M/63 T9 Left No L1 Right T9 Left No No Spinal SAH 5/M/73 T12 Left No L3 Right T12 Left T3 No None 6/M/64 T12 Left No L2 Left T12 Left No No SDAVF 7/M/48 T11 Left No L3 Right T11 Left No No SDAVF 8/M/55 L1 Right No L3 Right L1 Right No No SDAVF 9/M/72 T11 Left No L2 Right T11 Left No No SDAVF 10/M/66 L2 Left No L2 Right L2 Left No No SDAVF 11/F/43 T12 Left No No No L1 Left No No SAVM, fistulous type 12/F/43 T11 Right No L3 Left T11 Right No No None 13/M/73 T10 Left No L2 Right T10 Left No No SDAVF 14/F/76 T12 Right No L3 Right T12 Right No No SDAVF 15/M/59 L1 Left No L2 Right L1 Left No No None Note:—CE-MRA indicates contrast-enhanced magnetic resonance angiography; DSA, digital subtraction angiography; AKA, Adamkiewicz artery; ARA, anterior radiculomedullary artery; GARV, great anterior radiculomedullary vein; T, thoracic; L, lumbar; SDAVF, spinal dural anteriovenous fistula; SAVM, spinal arteriovenous malformation; SAH, subarachnoidal hemorrhage. For a description of the present spinal vascular pathology, we refer to the existing literature.30
- Table 2:
Comparison of image quality between contrast-enhanced magnetic resonance angiography (CE-MRA) and digital subtraction angiography (DSA)
Vessel Conspicuity Contrast Vessel Continuity Vessel Sharpness Background Homogeneity Relative score −0.7 ± 1.3 0.3 ± 1.4 −1.5 ± 0.6 −1.6 ± 1.1 −1.5 ± 0.8 T+/T− 25.5/96.5 71/34 0/119 0/120 0/114 P value >.05, NS >.05, NS <.001 <.001 <.001 Note:—A negative (positive) score indicates that DSA performs better (worse) than CE-MRA. Mean relative scores are ±1 SD. T values (+ or −) are based on a rank-sums test. NS indicates not significant.
