Utility of intra-procedural cone-beam computed tomography imaging for the determination of the artery of Adamkiewicz suspected by angiography during transarterial embolization for hemoptysis

PURPOSE: To evaluate the role of cone-beam computed tomography (CT) performed for the determination of the artery of Adamkiewicz (AKA) suspected by angiography during trans-catheter bronchial artery embolization for hemoptysis. METHODS: In this retrospective study, 17 patients with hemoptysis who underwent cone-beam CT for evaluation of the AKA prior to arterial embolization from December 2014 to March 2022 were included. During the angiographic session, two interventional radiologists selected the possible AKAs that were defined as obscured hairpin-curved vessels arising from the dorsal branch of the intercostal arteries and running towards the midline in the arterially enhanced phase. Contrast-enhanced cone-beam CT was performed as an adjunct to angiography to determine whether the indefinite AKA was a real AKA based on whether it was found to connect to the anterior spinal artery. RESULTS: Selective cone-beam CT was performed at 17 possible AKAs detected by selective arteriogram of the intercostal artery (ICA). Cone-beam CT allowed for the determination of AKAs in 16 cases (94.1%). As a result of cone-beam CT findings, 9 of 16 study arteries (56.3%) were judged as definite AKAs, and the remaining 7 (43.7%) were judged as definitely not AKAs but as the musculocutaneous branching from the dorsal branch of the ICA. In 1 of 17 cases (5.9%), cone-beam CT could not determine the AKA because of poor image quality caused by inadequate breath holding. An additional anterior radiculomedullary artery arising from the dorsal branch of the lower ICA because of the inflow of the contrast medium through the anastomosis was detected in one case by conebeam CT but not by angiography. CONCLUSION: Intraprocedural enhanced cone-beam CT performed as an adjunctive technique to angiography is sufficient for confident determination of the AKA, which is essential for the operators to perform accurate and safe arterial embolization for hemoptysis.