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Paper title	Spinal MR Angiography for the Reliable Identification of the Artery of Adamkiewicz and its Tributary Arteries
Paper code	P60
Authors	Johannes Konstantin Richter Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland Alan Arthur Peters Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland Danielle Vera Bower Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland René Laqua Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland Michael Ith Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland Soung Yung Kim Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland Bernd Jung Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland Johannes Thomas Heverhagen Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland Hendrik von Tengg-Kobligk Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland Frank Mosler Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland Speaker
Form of presentation	Poster
Topics	SSNR-Neuroradiology
Abstract text	Aims: This educational poster focuses on the image acquisition, identification, and precise reporting of the main feeder of the anterior spinal artery in the thoraco-lumbar segments. It covers 4 major areas, making use of clinical images to convey the benefits of high-resolution MR imaging at 3T in the imaging of spinal arteries in free-breathing patients in day-to-day routine. (1) The anatomy and function of the Artery of Adamkiewicz (also known as A. radicularis magna or AKA) as well as the clinical consequences from an occlusion are illustrated and explained. (2) The standard clinical situations are pointed out in which the identification of the AKA and of the level of its supply from the aorta is imperative. (3) The technical basis of the MRA (DixonVIBE) and the know-how needed to implement it and plan the exam are explained, in no more detail than is relevant to the clinical radiologist. (4) How to post-process the imaging data in order to achieve maximum identification rates of both AKA and its supplying arteries as well as for providing the clinicians with the best visualization of the imaging result for the referring clinician. Methods: Images were acquired on a 3T scanner using two 30-channel body coils. Imaging protocols include a T1 weighted, steady-state radial VIBE MRA with fat saturation as well as a first-pass MRA. Dedicated post-processing ist shown, including curved coronal MPR and MIP reformations to provide the clinician with a better visualization. Results: High-resolution MRA of the spinal arteries achieve excellent image quality using standard clinical equipment and dedicated post-processing done by a resident. Conclusion: Advantages of MRA over micro-invasive intra-arterial catheter-based angiography become evident with proper image acquisition, processing as well as focused reporting. At our institution, we have developed protocols for high-resolution 3T spinal MRA’s (both stady-state and first-pass) for patients with aortic aneurysms as a preoperative exam to help the cardiovascular surgeons prioritize which intercostal arteries are crucial for the perfusion of the anterior spinal artery and need to be inserted into the aortic graft. Spinal MRA has replaced CTA and DSA as the modality of choice for preoperative imaging of the spinal arterial supply in patients with aortic aneurysms at our institution.