Predictors of Adamkiewicz artery and anterior spinal artery detection through computerized tomographic angiography
Alexandre Campos Moraes Amato1, Jose Rodrigues Parga Filho2, Noedir Antonio Groppo Stolf3
1Post-Graduate Program, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Insights
Detecting the Adamkiewicz artery and anterior spinal artery is crucial for preventing spinal cord injury. Arterial disease and obesity are key risk factors impacting their visualization during CT angiography.
Area of Science:
- Vascular anatomy and surgical risk assessment.
- Radiology and medical imaging analysis.
- Predictive modeling in healthcare.
Background:
- The Adamkiewicz artery and anterior spinal artery are vital for spinal cord perfusion during aortic surgery.
- Preventing spinal cord ischemia relies on identifying these critical arteries.
- Predictive models for artery detectability are lacking.
Purpose of the Study:
- To develop a predictive model for visualizing the Adamkiewicz artery and anterior spinal artery.
- To identify key factors influencing the detectability of these spinal arteries using computerized tomographic angiography.
Main Methods:
- Prospective, cross-sectional study involving 110 participants.
- High-definition axial image inspection for artery visualization.
- Multiplanar 3D reconstruction using OsiriX® software.
Main Results:
- Arterial disease, hypertension, metabolic syndrome, and smoking are linked to non-detection.
- Obesity, particularly higher body mass index, was the most significant risk factor.
- Specific factors identified for Adamkiewicz artery and anterior spinal artery non-detection.
Conclusions:
- Established arterial disease and increased body mass index are significant risk factors for artery detection.
- Patients with these risk factors require specific diagnostic protocols.
- Enhanced detection protocols can improve visualization of these critical arteries.
Background:
The detection of the Adamkiewicz artery and the anterior spinal artery has been associated with the ability to prevent adverse spinal cord outcomes after aortic surgical procedures. Yet, to our knowledge, no previous studies have attempted to use modern predictive models to identify the most important variables in determining artery detectability.
Aims:
To develop a model to predict the odds of visualizing the Adamkiewicz artery or anterior spinal artery in patients undergoing computerized tomographic angiography.
Methods:
We conducted a prospective, cross-sectional study. Outcomes of interest were the non-detection of the Adamkiewicz artery and anterior spinal artery, and their corresponding level of origin. Axial images were inspected in high definition in search of two dense spots characterizing the Adamkiewicz artery and anterior spinal artery. A multiplanar three-dimensional reconstruction was then performed using the OsiriX® software.
Results:
A total of 110 participants were part of this analysis. When evaluating risks for the Adamkiewicz artery being undetectable, significant factors could be classified into three broad categories: risk factors for arterial disease, established arterial disease, and obesity. Factors in the former category included metabolic syndrome, hypertension, and smoking status, while factors in the arterial disease included descending aortic aneurysm, mural thrombi, aortic aneurysm without a dissection, and aortic disease in general. In relation to anterior spinal artery not being detectable, significant risk factors included hypertension, smoking status, and metabolic syndrome, while those associated with arterial disease involved aortic disease and arterial thrombi. When evaluating the importance of individual clinical factors, the presence of higher body mass index was the single most important risk factor.
Conclusion:
Arterial disease, established arterial disease, and increased body mass index are risk factors in the detection of Adamkiewicz artery and anterior spinal artery. Specific diagnostic protocols should be in place for patients with these underlying conditions, thus enhancing the likelihood of detection when the Adamkiewicz artery is indeed present.
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