Feasibility and validation of spinal cord vasculature imaging using high resolution ultrasound

Background: A noninvasive method of visualization of the anterior spinal artery such as ultrasound that can be utilized in emergent or intraoperative settings can reduce the risk of spinal cord ischemia. Objective: We assessed the feasibility of imaging and characterizing blood flow in the anterior spinal artery using ultrasound with concurrent validation using a cadaveric model. Methods: We developed a protocol for ultrasonographic assessment of anterior spinal artery based on anatomic, morphologic, and physiologic characteristics of anterior spinal artery and determined the feasibility in 24 healthy research participants using high frequency probe (3-9 MHz) through the left lateral paramedian approach in the area between T8 and T12. We ascertained the detection rate, depth of insonation, and flow parameters, including peak systolic velocity, end diastolic velocity, and resistivity indexes for both segmental arteries and anterior spinal artery within the field of insonation. We validated the anatomical landmarks using simultaneous spinal angiography and simulated anterior spinal artery flow in a cadaveric set-up. Results: We detected flow in all segmental arteries at different levels of our field of insonation with mean depth (+/- standard deviation) of insonation at 3.9 +/- 0.7 cm identified by characteristic high resistance flow pattern. Anterior spinal artery was detected in 15 (62.5%) research participants at mean depth (+/- standard deviation) of 6.4 +/- 1.2 cm identified by characteristic low resistance bidirectional flow. Age, gender, and body mass index were not correlated with either the detection rate or depth of insonation for anterior spinal artery. Simultaneous spinal angiography and simulated anterior spinal artery flow in a cadaveric set-up confirmed the validity of the anatomic landmarks by demonstrating concordance with results obtained from volunteer research participants. Conclusions: The current study describes a technique for noninvasive imaging of spinal vasculature using ultrasound which may enhance our diagnostic capabilities in emergent and intraoperative settings. (J Vasc Surg 2012;56:637-43.)