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Original Research: Procedures |

Course and Variation of the Intercostal Artery by CT ScanIntercostal Artery Position in Vivo

Emma J. Helm, MD; Najib M. Rahman, DPhil; Omid Talakoub, MSc; Danial L. Fox, MD; Fergus V. Gleeson, MD, FCCP
Author and Funding Information

From the Department of Radiology (Dr Helm), University Hospitals Coventry and Warwickshire National Health Service (NHS) Trust, Coventry, England; Oxford Centre for Respiratory Medicine and Oxford Pleural Diseases Unit (Dr Rahman), Churchill Hospital, Oxford, England; National Institute of Health Research (NIHR) Oxford Biomedical Research Centre (Drs Rahman and Gleeson), University of Oxford, Oxford, England; the Department of Radiology (Dr Gleeson), Oxford Radcliffe NHS Trust, Churchill Hospital, Oxford, England; the Department of Radiology (Dr Fox), Taunton and Somerset NHS Foundation Trust, Taunton, England; and the Department of Electrical and Computer Engineering (Mr Talakoub), University of Toronto, Toronto, ON, Canada.

Correspondence to: Fergus V. Gleeson, MD, FCCP, Department of Radiology, Oxford Radcliffe NHS Trust, Churchill Hospital, Oxford, OX3 7LJ, England; e-mail: Fergus.gleeson@nds.ox.ac.uk


Drs Helm and Rahman contributed equally to the design, conduct, and analysis of this study.

Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(3):634-639. doi:10.1378/chest.12-1285
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Background:  It is conventionally taught that the intercostal artery is shielded in the intercostal groove of the superior rib. The continuous course and variability of the intercostal artery, and factors that may influence them, have not been described in a large number of arteries in vivo.

Methods:  Maximal intensity projection reformats in the coronal plane were produced from CT scan pulmonary angiograms to identify the posterolateral course of the intercostal artery (seventh to 11th rib spaces). A novel semiautomated computer segmentation algorithm was used to measure distances between the lower border of the superior rib, the upper border of the inferior rib, and the position of the intercostal artery when exposed in the intercostal space. The position and variability of the artery were analyzed for association with clinical factors.

Results:  Two hundred ninety-eight arteries from 47 patients were analyzed. The mean lateral distance from the spine over which the artery was exposed within the intercostal space was 39 mm, with wide variability (SD, 10 mm; 10th-90th centile, 28-51 mm). At 3 cm lateral distance from the spine, 17% of arteries were shielded by the superior rib, compared with 97% at 6 cm. Exposed artery length was not associated with age, sex, rib space, or side. The variability of arterial position was significantly associated with age (coefficient, 0.91; P < .001) and rib space number (coefficient, −2.60; P < .001).

Conclusions:  The intercostal artery is exposed within the intercostal space in the first 6 cm lateral to the spine. The variability of its vertical position is greater in older patients and in more cephalad rib spaces.

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