Photon-Counting Detector CTA for Localization of the Artery of Adamkiewicz

Photo-counting detector CT is a relatively new technology that is becoming increasingly prevalent. In recent years, photon-counting CT has been shown to have benefits in numerous neuroradiologic clinical applications, including temporal bone imaging, detection of spinal CSF leaks, and CTA of the head, neck, and spine. New uses for photo-counting detector CT continue to emerge, capitalizing on the high spatial resolution and other advantages of this technology to improve patient care. One potential application in the spine is the detection and localization of the artery of Adamkiewicz, which provides the dominant supply to the inferior portion of the anterior spinal artery. Localization of this artery is sometimes needed before surgeries requiring ligation of the foraminal neurovascular complex. Traditional energy-integrating detector CT is useful but imperfect for the detection of this relatively small and transiently opacifying vessel. The improved spatial resolution and spectral information obtained with photon-counting CT may help improve the detection of the artery of Adamkiewicz. In this clinical report, we outline a protocol for imaging the artery of Adamkiewicz with photon-counting detector CT and describe a comparative analysis of 3 different reconstruction techniques in 6 consecutive patients who underwent this examination. We found that an intermediate sharp vascular kernel (Bv60) reconstructed with a low-energy threshold outperformed other conditions, including a sharper kernel and a low kiloelectron volt virtual monoenergetic reconstruction.