Comparison of magnetic resonance with computed tomography angiography for preoperative localization of the Adamkiewicz artery in thoracoabdominal aortic aneurysm patients

Objective Preoperative localization of the Adamkiewicz artery and its segmental supplier in advance of thoracic aortic aneurysm (TAA) and thoracoabdominal aortic aneurysm (TAAA) repair is proposed to be useful to prevent postoperative paraplegia. The diagnostic potential of magnetic resonance angiography (MRA) and computed tomography angiography (CTA) was evaluated for the preoperative localization of the Adamkiewicz artery in white TAAA patients. Methods Thirty-nine consecutive patients with a TAA(A) scheduled for elective open surgical aortic repair preoperatively underwent MRA and CTA. Objective image quality was assessed by measuring the signal-to-noise ratio and contrast-to-noise ratio of the Adamkiewicz artery and was related to patient thickness. Two independent observers scored the location of the Adamkiewicz artery and the subjective image quality of vessel-background contrast of the Adamkiewicz artery, image noise, spinal cord tissue enhancement, epidural venous enhancement, and overall image quality. Results Average detection rate for Adamkiewicz artery localization was 71% (67% to 74%) for CTA and 97% (94% to 100%) for MRA. Interobserver agreement was 82% for CTA and 94% for MRA. Signal-to-noise ratio was significantly higher ( P < .001) and contrast-to-noise ratio was significantly ( P < .001) lower for CTA than for MRA. Contrast of the Adamkiewicz artery ( P < .001) and overall image quality ( P < .004) were judged to be significantly better for MRA. Spinal cord tissue enhancement was judged stronger at CTA ( P < .03), with significantly less epidural venous enhancement ( P < .001). No significant difference was found in image noise. Signal-to-noise and contrast-to-noise decreased significantly ( P < .001) with increasing patient thickness for CTA but not for MRA. Conclusions Localization of the Adamkiewicz artery in white TAAA patients is possible with both CTA and MRA. Compared with CTA, MRA is more favorable because of the higher Adamkiewicz artery detection rate, the higher contrast-to-noise ratio, and its independence of patient thickness.