Evaluation of collateral pathways to the artery of Adamkiewicz using ultra-high-resolution CT

2020 Fiscal Year Final Research Report

• Project/Area Number: 18K07766
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 一般
• Review Section: Basic Section 52040:Radiological sciences-related
• Research Institution: Iwate Medical University
• Principal Investigator: YOSHIOKA Kunihiro 岩手医科大学, 医学部, 教授 (70210648)
• Project Period (FY): 2018-04-01 – 2021-03-31
• Keywords: Adamkiewicz動脈 / CT / 大動脈瘤

Outline of Final Research Achievements

A total of 89 patients with descending thoracic and thoracoabdominal aortic aneurysms were scanned using the ultra-high-resolution CT scanner (Precision, Canon Medical Systems, Otawara, Japan) with a 0.25-mm detector row width, supporting image reconstruction with a 1024 × 1024 matrix. The cardiovascular radiologists evaluated visualization of the artery of Adamkiewicz and its continuity between the anterior spinal artery and the aorta with CPR (curved planar reformation) images using a workstation (Ziostation, Ziosoft, Tokyo, Japan).
The artery of Adamkiewicz was depicted in 89 of 95 (94%) patients. The ultra-high-resolution CT demonstrated 26 collateral pathways in these 89 (22%) patients (Six patients had 2 collateral pathways). The collateral pathways were divided into 2 groups based on the location. One group included collateral pathways located around the spinal column (n = 26, 81%) and the other group included collateral pathways located in the thoracic wall (n = 5, 19%).

Free Research Field

放射線診断学

Academic Significance and Societal Importance of the Research Achievements

従来CTの8倍の空間分解能を有する超高精細CTでは、94％という極めて高い確率でAdamkiewicz動脈を描出できることが明らかになった。従来CTを用いた場合には、同じ方法での描出率は50ー60％程度であるので、今後Adamkiewicz動脈の診断には超高精細CTが第一選択となる可能性がある。また、超高精細CTは脊椎周囲や胸壁を走行する側副血行路も明瞭に描出可能で、今回の研究でその経路や頻度が明らかになった。これらの知見は、手術の前に側副血行路となっている動脈を同定することで、手術に際してそれらを再建したり温存する等の手術術式に影響を与えるばかりでなく、術後対麻痺の回避への貢献が期待できる。