Aim: To determine the optimal contrast medium injection protocol for demonstrating the Adamkiewicz artery (AKA) using 64-detector CT angiography (CTA).
Materials and methods: CTA was performed using 64-detector CT. The study population consisted of 80 patients (mean age 67.2 years) with aortoiliac diseases. In the first 60 patients 540 mg I/kg body weight was administered over 25s. The patients were randomly assigned to three protocols with imaging started at 15 (protocol A-1), 18 (A-2), or 21s (A-3) after triggering (threshold 150 HU). The other 20 received 720 mg I/kg body weight with an imaging delay of 18s (protocol B). Two radiologists evaluated the presence of the AKA and measured the attenuation of the aorta and AKA.
Results: Aortic enhancement was 360.4, 348, 279.3, and 372 HU for protocols A-1, A-2, A-3, and B, respectively. There was no significant difference between the A-1 and A-2 protocols (Tukey-Kramer test, p=0.73); however, aortic enhancement was significantly lower in A-3 than A-1 and A-2 (p<0.01). There was no significant difference between A-2 and B (p=0.40). AKA attenuation was 69.3, 91.9, 94.6, and 105.4 HU for protocols A-1, A-2, A-3, and B, respectively. There was no significant difference between the A-2 and A-3 protocols (p=0.91); however, AKA attenuation was significantly lower with A-1 than A-2 or A-3 (p=0.01). AKA attenuation was significantly lower with A-2 than B (p=0.03) and there was a significant difference between A-2 (50%) and B (95%) in the depiction of the hairpin configuration of the AKA (p=0.02).
Conclusion: For the demonstration of the AKA at CTA, the optimal protocol used an imaging delay of 18s after triggering and an iodine dose of 720 mg I/kg body weight.