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DSA, MRA, CTA: Imaging Spinal Arterial Anatomy and Pathology 2014

Category General Spine Michele H. Johnson Vahe Zohrabian, fellow Charles Matouk Ketan Bulsara Amit Mahajan Purpose To illustrate correlative spinal vacular anatomy and pathology using cross-sectional and catheter based techniques and to describe diagnostic and therapeutic strategies for patient assessment and management. Materials & Methods Clinical data base and teaching file material were retrospectively chosen to illustrate normal, variant and pathologic anatomy in patients with suspected spinal vascular lesions. Literature review of techniques for imaging assessment of spinal vascular anatomy are reviewed to suggest optimal strategies for diagnostic imaging of patients with suspected spinal vascular disease. Results Catheter digital subtration angiography of the spinal vasculature represents the reference standard for evaluation of spinal vascular anatomy and pathology, however the cost and relative risk has advanced the need for the development of noninvasive techniques. Spinal MRA, conventional and dual energy spinal CTA for assessment of the spinal vasculature are described and illustrated using normal and pathologic examples. Assessment of the spinal vasculature, particularly the artery of Ademkiewicz, in the setting of aortic aneurysm and spinal dural arteriovenous fistula are demonstrated. Conclusion Noninvasive and invasive spinal imaging are adjunctive in the evaluation of patients with suspected spinal vascular lesions. Accurate interpretation of cross-sectional spinal vascular anatomy requires an understanding of anatomy, pathology and flow characteristics optimally demonstrated by catheter angiography. Knowledge of correlative vascular anatomy can improve diagnostic yield on invasive and non-invasive imaging techniques. References Tubbs RS, Blouir MC, Romeo AK, Mortazavi MM, Cohen-Gadol AA. Spinal cord ischemia and atherosclerosis: a review of the literature. Br J Neurosurg. 2011 Dec;25(6):666-70. doi: 10.3109/02688697.2011.578774. Epub 2011 Jun 27.