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MR Angiography and CT Angiography of the Artery of Adamkiewicz: Noninvasive Preoperative Assessment of Thoracoabdominal Aortic Aneurysm¹

¹ From the Department of Radiology (K.Y., M.S.), the Second Department of Internal Medicine (H.N., A.O., K.N., T.K.), and the Department of Cardiovascular Surgery (K.K.), Memorial Heart Center, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate 020-8505, Japan. Presented as an education exhibit at the 2001 RSNA scientific assembly. Received February 19, 2002; revision requested March 20; final revision received February 1, 2003; accepted February 11. Address correspondence to K.Y. (e-mail: kyoshi@iwate-med.ac.jp).

View larger version (35K): [in a new window]   Figure 1a.  Drawings illustrate the arteries of the spinal cord and spine. (a) The thoracolumbar segment of the spinal cord is vascularized by branches of the thoracoabdominal aorta via the intercostal and lumbar arteries. (b) The intercostal or lumbar artery arises from the aorta and divides into anterior and posterior branches. The posterior branch subdivides into the radiculomedullary artery, the muscular branch, and the dorsal somatic branch. The radiculomedullary artery further subdivides into the anterior and posterior radiculomedullary arteries. (Fig 1 reprinted, with permission, from reference 18.)

View larger version (104K): [in a new window]   Figure 1b.  Drawings illustrate the arteries of the spinal cord and spine. (a) The thoracolumbar segment of the spinal cord is vascularized by branches of the thoracoabdominal aorta via the intercostal and lumbar arteries. (b) The intercostal or lumbar artery arises from the aorta and divides into anterior and posterior branches. The posterior branch subdivides into the radiculomedullary artery, the muscular branch, and the dorsal somatic branch. The radiculomedullary artery further subdivides into the anterior and posterior radiculomedullary arteries. (Fig 1 reprinted, with permission, from reference 18.)

View larger version (99K): [in a new window]   Figure 2a.  Differences in image quality owing to modality and section thickness. (a) Oblique coronal MPR image from MR angiography shows that the artery of Adamkiewicz originates from the radiculomedullary artery at the level of the left 10th-11th intercostal artery. (b, c) Oblique coronal MPR images from CT angiography with a 2-mm (b) and 1-mm (c) section thickness show the artery of Adamkiewicz. The radiculomedullary artery is seen just beneath the vertebra in c (arrow).

View larger version (75K): [in a new window]   Figure 2b.  Differences in image quality owing to modality and section thickness. (a) Oblique coronal MPR image from MR angiography shows that the artery of Adamkiewicz originates from the radiculomedullary artery at the level of the left 10th-11th intercostal artery. (b, c) Oblique coronal MPR images from CT angiography with a 2-mm (b) and 1-mm (c) section thickness show the artery of Adamkiewicz. The radiculomedullary artery is seen just beneath the vertebra in c (arrow).

View larger version (72K): [in a new window]   Figure 2c.  Differences in image quality owing to modality and section thickness. (a) Oblique coronal MPR image from MR angiography shows that the artery of Adamkiewicz originates from the radiculomedullary artery at the level of the left 10th-11th intercostal artery. (b, c) Oblique coronal MPR images from CT angiography with a 2-mm (b) and 1-mm (c) section thickness show the artery of Adamkiewicz. The radiculomedullary artery is seen just beneath the vertebra in c (arrow).

View larger version (113K): [in a new window]   Figure 3a.  True thoracoabdominal aortic aneurysm in a 63-year-old woman. (a) Oblique coronal MPR image from MR angiography shows the artery of Adamkiewicz (arrow), which branches from the left ninth radiculomedullary artery (arrowheads). The anterior spinal artery is continuous with the artery of Adamkiewicz, creating a hairpin turn. (b) Axial partial MPR image from MR angiography demonstrates continuity between the aorta (Ao) and the radiculomedullary artery (arrowhead). The anterior (a) and muscular (m) branches are also visualized. (c) Oblique coronal MPR image from CT angiography shows the artery of Adamkiewicz (arrow) and the radiculomedullary artery (arrowhead). (d) Oblique axial MPR image from CT angiography shows the proximal portion of the left ninth intercostal artery (arrow). (e) Oblique axial MPR image from CT angiography shows the radiculomedullary artery (arrowheads). The anterior branch (a) is also visualized.

View larger version (139K): [in a new window]   Figure 3b.  True thoracoabdominal aortic aneurysm in a 63-year-old woman. (a) Oblique coronal MPR image from MR angiography shows the artery of Adamkiewicz (arrow), which branches from the left ninth radiculomedullary artery (arrowheads). The anterior spinal artery is continuous with the artery of Adamkiewicz, creating a hairpin turn. (b) Axial partial MPR image from MR angiography demonstrates continuity between the aorta (Ao) and the radiculomedullary artery (arrowhead). The anterior (a) and muscular (m) branches are also visualized. (c) Oblique coronal MPR image from CT angiography shows the artery of Adamkiewicz (arrow) and the radiculomedullary artery (arrowhead). (d) Oblique axial MPR image from CT angiography shows the proximal portion of the left ninth intercostal artery (arrow). (e) Oblique axial MPR image from CT angiography shows the radiculomedullary artery (arrowheads). The anterior branch (a) is also visualized.

View larger version (69K): [in a new window]   Figure 3c.  True thoracoabdominal aortic aneurysm in a 63-year-old woman. (a) Oblique coronal MPR image from MR angiography shows the artery of Adamkiewicz (arrow), which branches from the left ninth radiculomedullary artery (arrowheads). The anterior spinal artery is continuous with the artery of Adamkiewicz, creating a hairpin turn. (b) Axial partial MPR image from MR angiography demonstrates continuity between the aorta (Ao) and the radiculomedullary artery (arrowhead). The anterior (a) and muscular (m) branches are also visualized. (c) Oblique coronal MPR image from CT angiography shows the artery of Adamkiewicz (arrow) and the radiculomedullary artery (arrowhead). (d) Oblique axial MPR image from CT angiography shows the proximal portion of the left ninth intercostal artery (arrow). (e) Oblique axial MPR image from CT angiography shows the radiculomedullary artery (arrowheads). The anterior branch (a) is also visualized.

View larger version (113K): [in a new window]   Figure 3d.  True thoracoabdominal aortic aneurysm in a 63-year-old woman. (a) Oblique coronal MPR image from MR angiography shows the artery of Adamkiewicz (arrow), which branches from the left ninth radiculomedullary artery (arrowheads). The anterior spinal artery is continuous with the artery of Adamkiewicz, creating a hairpin turn. (b) Axial partial MPR image from MR angiography demonstrates continuity between the aorta (Ao) and the radiculomedullary artery (arrowhead). The anterior (a) and muscular (m) branches are also visualized. (c) Oblique coronal MPR image from CT angiography shows the artery of Adamkiewicz (arrow) and the radiculomedullary artery (arrowhead). (d) Oblique axial MPR image from CT angiography shows the proximal portion of the left ninth intercostal artery (arrow). (e) Oblique axial MPR image from CT angiography shows the radiculomedullary artery (arrowheads). The anterior branch (a) is also visualized.

View larger version (140K): [in a new window]   Figure 3e.  True thoracoabdominal aortic aneurysm in a 63-year-old woman. (a) Oblique coronal MPR image from MR angiography shows the artery of Adamkiewicz (arrow), which branches from the left ninth radiculomedullary artery (arrowheads). The anterior spinal artery is continuous with the artery of Adamkiewicz, creating a hairpin turn. (b) Axial partial MPR image from MR angiography demonstrates continuity between the aorta (Ao) and the radiculomedullary artery (arrowhead). The anterior (a) and muscular (m) branches are also visualized. (c) Oblique coronal MPR image from CT angiography shows the artery of Adamkiewicz (arrow) and the radiculomedullary artery (arrowhead). (d) Oblique axial MPR image from CT angiography shows the proximal portion of the left ninth intercostal artery (arrow). (e) Oblique axial MPR image from CT angiography shows the radiculomedullary artery (arrowheads). The anterior branch (a) is also visualized.

View larger version (103K): [in a new window]   Figure 4a.  True thoracoabdominal aortic aneurysm in a 78-year-old man. (a-c) Oblique axial MPR images from CT angiography show the left ninth intercostal artery (arrow in a and b) and the radiculomedullary artery (arrowhead in c). (d) Planning image for the curved MPR image (cf e). (e) Curved MPR image from CT angiography clearly shows continuity of the aorta, intercostal artery, radiculomedullary artery, artery of Adamkiewicz (arrow), and anterior spinal artery.

View larger version (115K): [in a new window]   Figure 4b.  True thoracoabdominal aortic aneurysm in a 78-year-old man. (a-c) Oblique axial MPR images from CT angiography show the left ninth intercostal artery (arrow in a and b) and the radiculomedullary artery (arrowhead in c). (d) Planning image for the curved MPR image (cf e). (e) Curved MPR image from CT angiography clearly shows continuity of the aorta, intercostal artery, radiculomedullary artery, artery of Adamkiewicz (arrow), and anterior spinal artery.

View larger version (87K): [in a new window]   Figure 4c.  True thoracoabdominal aortic aneurysm in a 78-year-old man. (a-c) Oblique axial MPR images from CT angiography show the left ninth intercostal artery (arrow in a and b) and the radiculomedullary artery (arrowhead in c). (d) Planning image for the curved MPR image (cf e). (e) Curved MPR image from CT angiography clearly shows continuity of the aorta, intercostal artery, radiculomedullary artery, artery of Adamkiewicz (arrow), and anterior spinal artery.

View larger version (84K): [in a new window]   Figure 4d.  True thoracoabdominal aortic aneurysm in a 78-year-old man. (a-c) Oblique axial MPR images from CT angiography show the left ninth intercostal artery (arrow in a and b) and the radiculomedullary artery (arrowhead in c). (d) Planning image for the curved MPR image (cf e). (e) Curved MPR image from CT angiography clearly shows continuity of the aorta, intercostal artery, radiculomedullary artery, artery of Adamkiewicz (arrow), and anterior spinal artery.

View larger version (97K): [in a new window]   Figure 4e.  True thoracoabdominal aortic aneurysm in a 78-year-old man. (a-c) Oblique axial MPR images from CT angiography show the left ninth intercostal artery (arrow in a and b) and the radiculomedullary artery (arrowhead in c). (d) Planning image for the curved MPR image (cf e). (e) Curved MPR image from CT angiography clearly shows continuity of the aorta, intercostal artery, radiculomedullary artery, artery of Adamkiewicz (arrow), and anterior spinal artery.

View larger version (123K): [in a new window]   Figure 5a.  Dissecting thoracoabdominal aortic aneurysm in a 58-year-old woman. (a, b) On oblique coronal MPR images from MR angiography (a) and CT angiography (b), the artery of Adamkiewicz (arrow) is seen to originate from the left 11th radiculomedullary artery (arrowhead) at the level of the left 11th intercostal artery. (c) Axial MPR image from CT angiography performed at the level of the 11th intercostal artery shows the radiculomedullary artery (arrowhead). The proximal portion of the left 11th intercostal artery is not visualized. (d, e) Oblique axial MPR images from MR angiography demonstrate a patent left 10th intercostal artery (d) and occlusion of the proximal portion of the left 11th intercostal artery (arrow in e). (f, g) Oblique sagittal (f) and coronal (g) MPR images from MR angiography show occlusion of the proximal portion of the left 11th intercostal artery (arrow in f) and origination of the collateral artery from the muscular branch of the left 10th intercostal artery (arrowhead).

View larger version (90K): [in a new window]   Figure 5b.  Dissecting thoracoabdominal aortic aneurysm in a 58-year-old woman. (a, b) On oblique coronal MPR images from MR angiography (a) and CT angiography (b), the artery of Adamkiewicz (arrow) is seen to originate from the left 11th radiculomedullary artery (arrowhead) at the level of the left 11th intercostal artery. (c) Axial MPR image from CT angiography performed at the level of the 11th intercostal artery shows the radiculomedullary artery (arrowhead). The proximal portion of the left 11th intercostal artery is not visualized. (d, e) Oblique axial MPR images from MR angiography demonstrate a patent left 10th intercostal artery (d) and occlusion of the proximal portion of the left 11th intercostal artery (arrow in e). (f, g) Oblique sagittal (f) and coronal (g) MPR images from MR angiography show occlusion of the proximal portion of the left 11th intercostal artery (arrow in f) and origination of the collateral artery from the muscular branch of the left 10th intercostal artery (arrowhead).

View larger version (78K): [in a new window]   Figure 5c.  Dissecting thoracoabdominal aortic aneurysm in a 58-year-old woman. (a, b) On oblique coronal MPR images from MR angiography (a) and CT angiography (b), the artery of Adamkiewicz (arrow) is seen to originate from the left 11th radiculomedullary artery (arrowhead) at the level of the left 11th intercostal artery. (c) Axial MPR image from CT angiography performed at the level of the 11th intercostal artery shows the radiculomedullary artery (arrowhead). The proximal portion of the left 11th intercostal artery is not visualized. (d, e) Oblique axial MPR images from MR angiography demonstrate a patent left 10th intercostal artery (d) and occlusion of the proximal portion of the left 11th intercostal artery (arrow in e). (f, g) Oblique sagittal (f) and coronal (g) MPR images from MR angiography show occlusion of the proximal portion of the left 11th intercostal artery (arrow in f) and origination of the collateral artery from the muscular branch of the left 10th intercostal artery (arrowhead).

View larger version (174K): [in a new window]   Figure 5d.  Dissecting thoracoabdominal aortic aneurysm in a 58-year-old woman. (a, b) On oblique coronal MPR images from MR angiography (a) and CT angiography (b), the artery of Adamkiewicz (arrow) is seen to originate from the left 11th radiculomedullary artery (arrowhead) at the level of the left 11th intercostal artery. (c) Axial MPR image from CT angiography performed at the level of the 11th intercostal artery shows the radiculomedullary artery (arrowhead). The proximal portion of the left 11th intercostal artery is not visualized. (d, e) Oblique axial MPR images from MR angiography demonstrate a patent left 10th intercostal artery (d) and occlusion of the proximal portion of the left 11th intercostal artery (arrow in e). (f, g) Oblique sagittal (f) and coronal (g) MPR images from MR angiography show occlusion of the proximal portion of the left 11th intercostal artery (arrow in f) and origination of the collateral artery from the muscular branch of the left 10th intercostal artery (arrowhead).

View larger version (163K): [in a new window]   Figure 5e.  Dissecting thoracoabdominal aortic aneurysm in a 58-year-old woman. (a, b) On oblique coronal MPR images from MR angiography (a) and CT angiography (b), the artery of Adamkiewicz (arrow) is seen to originate from the left 11th radiculomedullary artery (arrowhead) at the level of the left 11th intercostal artery. (c) Axial MPR image from CT angiography performed at the level of the 11th intercostal artery shows the radiculomedullary artery (arrowhead). The proximal portion of the left 11th intercostal artery is not visualized. (d, e) Oblique axial MPR images from MR angiography demonstrate a patent left 10th intercostal artery (d) and occlusion of the proximal portion of the left 11th intercostal artery (arrow in e). (f, g) Oblique sagittal (f) and coronal (g) MPR images from MR angiography show occlusion of the proximal portion of the left 11th intercostal artery (arrow in f) and origination of the collateral artery from the muscular branch of the left 10th intercostal artery (arrowhead).

View larger version (104K): [in a new window]   Figure 5f.  Dissecting thoracoabdominal aortic aneurysm in a 58-year-old woman. (a, b) On oblique coronal MPR images from MR angiography (a) and CT angiography (b), the artery of Adamkiewicz (arrow) is seen to originate from the left 11th radiculomedullary artery (arrowhead) at the level of the left 11th intercostal artery. (c) Axial MPR image from CT angiography performed at the level of the 11th intercostal artery shows the radiculomedullary artery (arrowhead). The proximal portion of the left 11th intercostal artery is not visualized. (d, e) Oblique axial MPR images from MR angiography demonstrate a patent left 10th intercostal artery (d) and occlusion of the proximal portion of the left 11th intercostal artery (arrow in e). (f, g) Oblique sagittal (f) and coronal (g) MPR images from MR angiography show occlusion of the proximal portion of the left 11th intercostal artery (arrow in f) and origination of the collateral artery from the muscular branch of the left 10th intercostal artery (arrowhead).

View larger version (101K): [in a new window]   Figure 5g.  Dissecting thoracoabdominal aortic aneurysm in a 58-year-old woman. (a, b) On oblique coronal MPR images from MR angiography (a) and CT angiography (b), the artery of Adamkiewicz (arrow) is seen to originate from the left 11th radiculomedullary artery (arrowhead) at the level of the left 11th intercostal artery. (c) Axial MPR image from CT angiography performed at the level of the 11th intercostal artery shows the radiculomedullary artery (arrowhead). The proximal portion of the left 11th intercostal artery is not visualized. (d, e) Oblique axial MPR images from MR angiography demonstrate a patent left 10th intercostal artery (d) and occlusion of the proximal portion of the left 11th intercostal artery (arrow in e). (f, g) Oblique sagittal (f) and coronal (g) MPR images from MR angiography show occlusion of the proximal portion of the left 11th intercostal artery (arrow in f) and origination of the collateral artery from the muscular branch of the left 10th intercostal artery (arrowhead).

View larger version (168K): [in a new window]   Figure 6a.  True thoracic aneurysm in a 74-year-old man. (a) Oblique coronal MIP image from CT angiography shows a thoracic aneurysm with a stomach-like shape. (b) Coronal MPR image from MR angiography shows the anterior spinal artery and the artery of Adamkiewicz (arrow) branching from the left ninth intercostal artery. (c) Oblique sagittal MPR image from MR angiography shows a small left ninth intercostal artery (arrow) and a small collateral vessel between the left 9th and 10th intercostal arteries (arrowhead). (d, e) Oblique partial MIP images from MR angiography show stenosis of the left ninth intercostal artery (arrow in d) and a patent left 10th intercostal artery (e). (f) Oblique coronal MPR image from MR angiography also shows the small collateral vessel (arrow) between the left 9th and 10th intercostal arteries (cf c). A graft replacement of the descending aorta from the fifth to the ninth thoracic level was successfully performed. A distal anastomosis was created just above the 10th intercostal artery. The left ninth intercostal artery was sutured, and the left 10th intercostal artery was preserved without any reconstruction of intercostal arteries. No paraplegia occurred after surgical repair. (g) Postoperative volume-rendered image from CT angiography shows a patent left 10th intercostal artery (arrow). (h) Postoperative oblique sagittal MPR image from MR angiography shows dilatation of the collateral vessel between the left 9th and 10th intercostal arteries (arrow). (i, j) Postoperative axial MPR images from MR angiography show occlusion of the ninth intercostal artery (arrow in i) and a patent 10th intercostal artery (j). (k) Oblique coronal MPR image from MR angiography shows the dilated collateral vessel between the left 9th and 10th intercostal arteries (arrow). (l) Coronal MPR image from MR angiography shows a patent artery of Adamkiewicz (arrow) and anterior spinal artery.

View larger version (92K): [in a new window]   Figure 6b.  True thoracic aneurysm in a 74-year-old man. (a) Oblique coronal MIP image from CT angiography shows a thoracic aneurysm with a stomach-like shape. (b) Coronal MPR image from MR angiography shows the anterior spinal artery and the artery of Adamkiewicz (arrow) branching from the left ninth intercostal artery. (c) Oblique sagittal MPR image from MR angiography shows a small left ninth intercostal artery (arrow) and a small collateral vessel between the left 9th and 10th intercostal arteries (arrowhead). (d, e) Oblique partial MIP images from MR angiography show stenosis of the left ninth intercostal artery (arrow in d) and a patent left 10th intercostal artery (e). (f) Oblique coronal MPR image from MR angiography also shows the small collateral vessel (arrow) between the left 9th and 10th intercostal arteries (cf c). A graft replacement of the descending aorta from the fifth to the ninth thoracic level was successfully performed. A distal anastomosis was created just above the 10th intercostal artery. The left ninth intercostal artery was sutured, and the left 10th intercostal artery was preserved without any reconstruction of intercostal arteries. No paraplegia occurred after surgical repair. (g) Postoperative volume-rendered image from CT angiography shows a patent left 10th intercostal artery (arrow). (h) Postoperative oblique sagittal MPR image from MR angiography shows dilatation of the collateral vessel between the left 9th and 10th intercostal arteries (arrow). (i, j) Postoperative axial MPR images from MR angiography show occlusion of the ninth intercostal artery (arrow in i) and a patent 10th intercostal artery (j). (k) Oblique coronal MPR image from MR angiography shows the dilated collateral vessel between the left 9th and 10th intercostal arteries (arrow). (l) Coronal MPR image from MR angiography shows a patent artery of Adamkiewicz (arrow) and anterior spinal artery.

View larger version (168K): [in a new window]   Figure 6c.  True thoracic aneurysm in a 74-year-old man. (a) Oblique coronal MIP image from CT angiography shows a thoracic aneurysm with a stomach-like shape. (b) Coronal MPR image from MR angiography shows the anterior spinal artery and the artery of Adamkiewicz (arrow) branching from the left ninth intercostal artery. (c) Oblique sagittal MPR image from MR angiography shows a small left ninth intercostal artery (arrow) and a small collateral vessel between the left 9th and 10th intercostal arteries (arrowhead). (d, e) Oblique partial MIP images from MR angiography show stenosis of the left ninth intercostal artery (arrow in d) and a patent left 10th intercostal artery (e). (f) Oblique coronal MPR image from MR angiography also shows the small collateral vessel (arrow) between the left 9th and 10th intercostal arteries (cf c). A graft replacement of the descending aorta from the fifth to the ninth thoracic level was successfully performed. A distal anastomosis was created just above the 10th intercostal artery. The left ninth intercostal artery was sutured, and the left 10th intercostal artery was preserved without any reconstruction of intercostal arteries. No paraplegia occurred after surgical repair. (g) Postoperative volume-rendered image from CT angiography shows a patent left 10th intercostal artery (arrow). (h) Postoperative oblique sagittal MPR image from MR angiography shows dilatation of the collateral vessel between the left 9th and 10th intercostal arteries (arrow). (i, j) Postoperative axial MPR images from MR angiography show occlusion of the ninth intercostal artery (arrow in i) and a patent 10th intercostal artery (j). (k) Oblique coronal MPR image from MR angiography shows the dilated collateral vessel between the left 9th and 10th intercostal arteries (arrow). (l) Coronal MPR image from MR angiography shows a patent artery of Adamkiewicz (arrow) and anterior spinal artery.

View larger version (103K): [in a new window]   Figure 6d.  True thoracic aneurysm in a 74-year-old man. (a) Oblique coronal MIP image from CT angiography shows a thoracic aneurysm with a stomach-like shape. (b) Coronal MPR image from MR angiography shows the anterior spinal artery and the artery of Adamkiewicz (arrow) branching from the left ninth intercostal artery. (c) Oblique sagittal MPR image from MR angiography shows a small left ninth intercostal artery (arrow) and a small collateral vessel between the left 9th and 10th intercostal arteries (arrowhead). (d, e) Oblique partial MIP images from MR angiography show stenosis of the left ninth intercostal artery (arrow in d) and a patent left 10th intercostal artery (e). (f) Oblique coronal MPR image from MR angiography also shows the small collateral vessel (arrow) between the left 9th and 10th intercostal arteries (cf c). A graft replacement of the descending aorta from the fifth to the ninth thoracic level was successfully performed. A distal anastomosis was created just above the 10th intercostal artery. The left ninth intercostal artery was sutured, and the left 10th intercostal artery was preserved without any reconstruction of intercostal arteries. No paraplegia occurred after surgical repair. (g) Postoperative volume-rendered image from CT angiography shows a patent left 10th intercostal artery (arrow). (h) Postoperative oblique sagittal MPR image from MR angiography shows dilatation of the collateral vessel between the left 9th and 10th intercostal arteries (arrow). (i, j) Postoperative axial MPR images from MR angiography show occlusion of the ninth intercostal artery (arrow in i) and a patent 10th intercostal artery (j). (k) Oblique coronal MPR image from MR angiography shows the dilated collateral vessel between the left 9th and 10th intercostal arteries (arrow). (l) Coronal MPR image from MR angiography shows a patent artery of Adamkiewicz (arrow) and anterior spinal artery.

View larger version (117K): [in a new window]   Figure 6e.  True thoracic aneurysm in a 74-year-old man. (a) Oblique coronal MIP image from CT angiography shows a thoracic aneurysm with a stomach-like shape. (b) Coronal MPR image from MR angiography shows the anterior spinal artery and the artery of Adamkiewicz (arrow) branching from the left ninth intercostal artery. (c) Oblique sagittal MPR image from MR angiography shows a small left ninth intercostal artery (arrow) and a small collateral vessel between the left 9th and 10th intercostal arteries (arrowhead). (d, e) Oblique partial MIP images from MR angiography show stenosis of the left ninth intercostal artery (arrow in d) and a patent left 10th intercostal artery (e). (f) Oblique coronal MPR image from MR angiography also shows the small collateral vessel (arrow) between the left 9th and 10th intercostal arteries (cf c). A graft replacement of the descending aorta from the fifth to the ninth thoracic level was successfully performed. A distal anastomosis was created just above the 10th intercostal artery. The left ninth intercostal artery was sutured, and the left 10th intercostal artery was preserved without any reconstruction of intercostal arteries. No paraplegia occurred after surgical repair. (g) Postoperative volume-rendered image from CT angiography shows a patent left 10th intercostal artery (arrow). (h) Postoperative oblique sagittal MPR image from MR angiography shows dilatation of the collateral vessel between the left 9th and 10th intercostal arteries (arrow). (i, j) Postoperative axial MPR images from MR angiography show occlusion of the ninth intercostal artery (arrow in i) and a patent 10th intercostal artery (j). (k) Oblique coronal MPR image from MR angiography shows the dilated collateral vessel between the left 9th and 10th intercostal arteries (arrow). (l) Coronal MPR image from MR angiography shows a patent artery of Adamkiewicz (arrow) and anterior spinal artery.

View larger version (91K): [in a new window]   Figure 6f.  True thoracic aneurysm in a 74-year-old man. (a) Oblique coronal MIP image from CT angiography shows a thoracic aneurysm with a stomach-like shape. (b) Coronal MPR image from MR angiography shows the anterior spinal artery and the artery of Adamkiewicz (arrow) branching from the left ninth intercostal artery. (c) Oblique sagittal MPR image from MR angiography shows a small left ninth intercostal artery (arrow) and a small collateral vessel between the left 9th and 10th intercostal arteries (arrowhead). (d, e) Oblique partial MIP images from MR angiography show stenosis of the left ninth intercostal artery (arrow in d) and a patent left 10th intercostal artery (e). (f) Oblique coronal MPR image from MR angiography also shows the small collateral vessel (arrow) between the left 9th and 10th intercostal arteries (cf c). A graft replacement of the descending aorta from the fifth to the ninth thoracic level was successfully performed. A distal anastomosis was created just above the 10th intercostal artery. The left ninth intercostal artery was sutured, and the left 10th intercostal artery was preserved without any reconstruction of intercostal arteries. No paraplegia occurred after surgical repair. (g) Postoperative volume-rendered image from CT angiography shows a patent left 10th intercostal artery (arrow). (h) Postoperative oblique sagittal MPR image from MR angiography shows dilatation of the collateral vessel between the left 9th and 10th intercostal arteries (arrow). (i, j) Postoperative axial MPR images from MR angiography show occlusion of the ninth intercostal artery (arrow in i) and a patent 10th intercostal artery (j). (k) Oblique coronal MPR image from MR angiography shows the dilated collateral vessel between the left 9th and 10th intercostal arteries (arrow). (l) Coronal MPR image from MR angiography shows a patent artery of Adamkiewicz (arrow) and anterior spinal artery.

View larger version (149K): [in a new window]   Figure 6g.  True thoracic aneurysm in a 74-year-old man. (a) Oblique coronal MIP image from CT angiography shows a thoracic aneurysm with a stomach-like shape. (b) Coronal MPR image from MR angiography shows the anterior spinal artery and the artery of Adamkiewicz (arrow) branching from the left ninth intercostal artery. (c) Oblique sagittal MPR image from MR angiography shows a small left ninth intercostal artery (arrow) and a small collateral vessel between the left 9th and 10th intercostal arteries (arrowhead). (d, e) Oblique partial MIP images from MR angiography show stenosis of the left ninth intercostal artery (arrow in d) and a patent left 10th intercostal artery (e). (f) Oblique coronal MPR image from MR angiography also shows the small collateral vessel (arrow) between the left 9th and 10th intercostal arteries (cf c). A graft replacement of the descending aorta from the fifth to the ninth thoracic level was successfully performed. A distal anastomosis was created just above the 10th intercostal artery. The left ninth intercostal artery was sutured, and the left 10th intercostal artery was preserved without any reconstruction of intercostal arteries. No paraplegia occurred after surgical repair. (g) Postoperative volume-rendered image from CT angiography shows a patent left 10th intercostal artery (arrow). (h) Postoperative oblique sagittal MPR image from MR angiography shows dilatation of the collateral vessel between the left 9th and 10th intercostal arteries (arrow). (i, j) Postoperative axial MPR images from MR angiography show occlusion of the ninth intercostal artery (arrow in i) and a patent 10th intercostal artery (j). (k) Oblique coronal MPR image from MR angiography shows the dilated collateral vessel between the left 9th and 10th intercostal arteries (arrow). (l) Coronal MPR image from MR angiography shows a patent artery of Adamkiewicz (arrow) and anterior spinal artery.

View larger version (180K): [in a new window]   Figure 6h.  True thoracic aneurysm in a 74-year-old man. (a) Oblique coronal MIP image from CT angiography shows a thoracic aneurysm with a stomach-like shape. (b) Coronal MPR image from MR angiography shows the anterior spinal artery and the artery of Adamkiewicz (arrow) branching from the left ninth intercostal artery. (c) Oblique sagittal MPR image from MR angiography shows a small left ninth intercostal artery (arrow) and a small collateral vessel between the left 9th and 10th intercostal arteries (arrowhead). (d, e) Oblique partial MIP images from MR angiography show stenosis of the left ninth intercostal artery (arrow in d) and a patent left 10th intercostal artery (e). (f) Oblique coronal MPR image from MR angiography also shows the small collateral vessel (arrow) between the left 9th and 10th intercostal arteries (cf c). A graft replacement of the descending aorta from the fifth to the ninth thoracic level was successfully performed. A distal anastomosis was created just above the 10th intercostal artery. The left ninth intercostal artery was sutured, and the left 10th intercostal artery was preserved without any reconstruction of intercostal arteries. No paraplegia occurred after surgical repair. (g) Postoperative volume-rendered image from CT angiography shows a patent left 10th intercostal artery (arrow). (h) Postoperative oblique sagittal MPR image from MR angiography shows dilatation of the collateral vessel between the left 9th and 10th intercostal arteries (arrow). (i, j) Postoperative axial MPR images from MR angiography show occlusion of the ninth intercostal artery (arrow in i) and a patent 10th intercostal artery (j). (k) Oblique coronal MPR image from MR angiography shows the dilated collateral vessel between the left 9th and 10th intercostal arteries (arrow). (l) Coronal MPR image from MR angiography shows a patent artery of Adamkiewicz (arrow) and anterior spinal artery.

View larger version (136K): [in a new window]   Figure 6i.  True thoracic aneurysm in a 74-year-old man. (a) Oblique coronal MIP image from CT angiography shows a thoracic aneurysm with a stomach-like shape. (b) Coronal MPR image from MR angiography shows the anterior spinal artery and the artery of Adamkiewicz (arrow) branching from the left ninth intercostal artery. (c) Oblique sagittal MPR image from MR angiography shows a small left ninth intercostal artery (arrow) and a small collateral vessel between the left 9th and 10th intercostal arteries (arrowhead). (d, e) Oblique partial MIP images from MR angiography show stenosis of the left ninth intercostal artery (arrow in d) and a patent left 10th intercostal artery (e). (f) Oblique coronal MPR image from MR angiography also shows the small collateral vessel (arrow) between the left 9th and 10th intercostal arteries (cf c). A graft replacement of the descending aorta from the fifth to the ninth thoracic level was successfully performed. A distal anastomosis was created just above the 10th intercostal artery. The left ninth intercostal artery was sutured, and the left 10th intercostal artery was preserved without any reconstruction of intercostal arteries. No paraplegia occurred after surgical repair. (g) Postoperative volume-rendered image from CT angiography shows a patent left 10th intercostal artery (arrow). (h) Postoperative oblique sagittal MPR image from MR angiography shows dilatation of the collateral vessel between the left 9th and 10th intercostal arteries (arrow). (i, j) Postoperative axial MPR images from MR angiography show occlusion of the ninth intercostal artery (arrow in i) and a patent 10th intercostal artery (j). (k) Oblique coronal MPR image from MR angiography shows the dilated collateral vessel between the left 9th and 10th intercostal arteries (arrow). (l) Coronal MPR image from MR angiography shows a patent artery of Adamkiewicz (arrow) and anterior spinal artery.

View larger version (143K): [in a new window]   Figure 6j.  True thoracic aneurysm in a 74-year-old man. (a) Oblique coronal MIP image from CT angiography shows a thoracic aneurysm with a stomach-like shape. (b) Coronal MPR image from MR angiography shows the anterior spinal artery and the artery of Adamkiewicz (arrow) branching from the left ninth intercostal artery. (c) Oblique sagittal MPR image from MR angiography shows a small left ninth intercostal artery (arrow) and a small collateral vessel between the left 9th and 10th intercostal arteries (arrowhead). (d, e) Oblique partial MIP images from MR angiography show stenosis of the left ninth intercostal artery (arrow in d) and a patent left 10th intercostal artery (e). (f) Oblique coronal MPR image from MR angiography also shows the small collateral vessel (arrow) between the left 9th and 10th intercostal arteries (cf c). A graft replacement of the descending aorta from the fifth to the ninth thoracic level was successfully performed. A distal anastomosis was created just above the 10th intercostal artery. The left ninth intercostal artery was sutured, and the left 10th intercostal artery was preserved without any reconstruction of intercostal arteries. No paraplegia occurred after surgical repair. (g) Postoperative volume-rendered image from CT angiography shows a patent left 10th intercostal artery (arrow). (h) Postoperative oblique sagittal MPR image from MR angiography shows dilatation of the collateral vessel between the left 9th and 10th intercostal arteries (arrow). (i, j) Postoperative axial MPR images from MR angiography show occlusion of the ninth intercostal artery (arrow in i) and a patent 10th intercostal artery (j). (k) Oblique coronal MPR image from MR angiography shows the dilated collateral vessel between the left 9th and 10th intercostal arteries (arrow). (l) Coronal MPR image from MR angiography shows a patent artery of Adamkiewicz (arrow) and anterior spinal artery.

View larger version (134K): [in a new window]   Figure 6k.  True thoracic aneurysm in a 74-year-old man. (a) Oblique coronal MIP image from CT angiography shows a thoracic aneurysm with a stomach-like shape. (b) Coronal MPR image from MR angiography shows the anterior spinal artery and the artery of Adamkiewicz (arrow) branching from the left ninth intercostal artery. (c) Oblique sagittal MPR image from MR angiography shows a small left ninth intercostal artery (arrow) and a small collateral vessel between the left 9th and 10th intercostal arteries (arrowhead). (d, e) Oblique partial MIP images from MR angiography show stenosis of the left ninth intercostal artery (arrow in d) and a patent left 10th intercostal artery (e). (f) Oblique coronal MPR image from MR angiography also shows the small collateral vessel (arrow) between the left 9th and 10th intercostal arteries (cf c). A graft replacement of the descending aorta from the fifth to the ninth thoracic level was successfully performed. A distal anastomosis was created just above the 10th intercostal artery. The left ninth intercostal artery was sutured, and the left 10th intercostal artery was preserved without any reconstruction of intercostal arteries. No paraplegia occurred after surgical repair. (g) Postoperative volume-rendered image from CT angiography shows a patent left 10th intercostal artery (arrow). (h) Postoperative oblique sagittal MPR image from MR angiography shows dilatation of the collateral vessel between the left 9th and 10th intercostal arteries (arrow). (i, j) Postoperative axial MPR images from MR angiography show occlusion of the ninth intercostal artery (arrow in i) and a patent 10th intercostal artery (j). (k) Oblique coronal MPR image from MR angiography shows the dilated collateral vessel between the left 9th and 10th intercostal arteries (arrow). (l) Coronal MPR image from MR angiography shows a patent artery of Adamkiewicz (arrow) and anterior spinal artery.

View larger version (125K): [in a new window]   Figure 6l.  True thoracic aneurysm in a 74-year-old man. (a) Oblique coronal MIP image from CT angiography shows a thoracic aneurysm with a stomach-like shape. (b) Coronal MPR image from MR angiography shows the anterior spinal artery and the artery of Adamkiewicz (arrow) branching from the left ninth intercostal artery. (c) Oblique sagittal MPR image from MR angiography shows a small left ninth intercostal artery (arrow) and a small collateral vessel between the left 9th and 10th intercostal arteries (arrowhead). (d, e) Oblique partial MIP images from MR angiography show stenosis of the left ninth intercostal artery (arrow in d) and a patent left 10th intercostal artery (e). (f) Oblique coronal MPR image from MR angiography also shows the small collateral vessel (arrow) between the left 9th and 10th intercostal arteries (cf c). A graft replacement of the descending aorta from the fifth to the ninth thoracic level was successfully performed. A distal anastomosis was created just above the 10th intercostal artery. The left ninth intercostal artery was sutured, and the left 10th intercostal artery was preserved without any reconstruction of intercostal arteries. No paraplegia occurred after surgical repair. (g) Postoperative volume-rendered image from CT angiography shows a patent left 10th intercostal artery (arrow). (h) Postoperative oblique sagittal MPR image from MR angiography shows dilatation of the collateral vessel between the left 9th and 10th intercostal arteries (arrow). (i, j) Postoperative axial MPR images from MR angiography show occlusion of the ninth intercostal artery (arrow in i) and a patent 10th intercostal artery (j). (k) Oblique coronal MPR image from MR angiography shows the dilated collateral vessel between the left 9th and 10th intercostal arteries (arrow). (l) Coronal MPR image from MR angiography shows a patent artery of Adamkiewicz (arrow) and anterior spinal artery.