Preoperative imaging for deep inferior epigastric perforator flaps: A comparative study of computed tomographic angiography and magnetic resonance angiography

被引：13

作者：

Julien Pauchot

Sebastien Aubry

Adrian Kastler

Olivia Laurent

Bruno Kastler

Yves Tropet

机构：

[1] Orthopedic, Traumatology, Plastic Reconstructive and Hand Surgery Unit, University Hospital of Besançon, 25030 Besançon, place Saint Jacques

[2] Research Unit: EA 4268 I4S IFR 133 INSERM, University of Franche-Comté

[3] Department of Radiology, University Hospital of Besançon, 25030 Besançon, Boulevard Flemming

[4] Department of Radiology, University Hospital of Clermont-Ferrand, 63000 Clermont-Ferrand, Place Henry Dunant

来源：

European Journal of Plastic Surgery | 2012年 / 35卷 / 11期

关键词：

Breast reconstruction; Comparative study; Computed tomography angiography; DIEP flap; Epigastric arteries; Magnetic resonance angiography;

D O I：

10.1007/s00238-012-0740-0

中图分类号：

学科分类号：

摘要：

Background: Breast reconstruction with transverse rectus abdominis myocutaneous flap has evolved towards the intramuscular dissection of perforators of the deep inferior epigastric pedicle to reduce abdominal wall morbidity. We aimed to compare magnetic resonance angiography (MRA) and computed tomography angiography (CTA) findings for the identification of deep inferior epigastric perforators (DIEP) flap and to compare the results with intraoperative findings. Methods: This was a prospective comparative study that was approved by the local ethics committee, and written informed consent was obtained. Ten patients underwent both MRA and CTA scans prior to DIEP flap breast reconstruction. The perforators that were identified by MRA, CTA and surgery were projected on a scaled grid. The contrast ratios between the vessels and surrounding tissues were calculated and compared using a bilateral t test. Results: Totals of 67 and 59 perforators were found with MRA mapping and CTA, respectively. Fifty-six perforators were found with both techniques. All 70 perforators identified (MRA and CTA) were found during surgery. The estimated sensitivities for CTA and MRA were 84 and 96 %, respectively. Both techniques showed specificities of 100 %. The contrast analysis showed a better contrast of the fat-surrounded vessels with CTA (p=0.007) compared with MRA. However, a better contrast of the muscle-surrounded vessels was observed with MRA (p=0.001) compared with CTA. Conclusions: Our study found a higher sensitivity with MRA in identifying perforators compared with CTA. This difference can be explained by a higher contrast of vessels in muscles that facilitates identification, especially in cases in which perforators are within aponeuroses. Level of Evidence: Level II: Diagnostic study © 2012 Springer-Verlag.

引用

页码：795 / 801

页数：6

共 35 条

[1]

Hartrampf C.R., Scheflan M., Black P.W., Breast reconstruction with a transverse abdominal island flap, Plast Reconstr Surg, 69, pp. 216-225, (1982)

[2]

Blondeel N., Vanderstraeten G.G., Monstrey S.J., Van Landuyt K., Tonnard P., Lysens R., Boeckx W.D., Matton G., The donor site morbidity of free DIEP flaps and free TRAM flaps for breast reconstruction, Br J Plast Surg, 50, pp. 322-330, (1997)

[3]

Nahabedian M.Y., Momen B., Galdino G., Manson P.N., Breast reconstruction with the free TRAM or DIEP flap: Patient selection, choice of flap, and outcome, Plast Reconstr Surg, 110, pp. 466-475, (2002)

[4]

Casey III W.J., Chew R.T., Rebecca A.M., Smith A.A., Collins J.M., Pockaj B.A., Advantages of preoperative computed tomography in deep inferior epigastric artery perforator flap breast reconstruction, Plast Reconstr Surg, 123, pp. 1148-1155, (2009)

[5]

Ghattaura A., Henton J., Jallali N., Rajapakse Y., Savidge C., Allen S., Searle A.E., Harris P.A., James S.E., One hundred cases of abdominal-based free flaps in breast reconstruction. The impact of preoperative computed tomographic angiography, J Plast Reconstr Aesthet Surg, 63, pp. 1597-1601, (2010)

[6]

Rozen W.M., Ashton M.W., Stella D.L., Phillips T.J., Taylor G.I., The accuracy of computed tomographic angiography for mapping the perforators of the DIEA: A cadaveric study, Plast Reconstr Surg, 122, pp. 363-369, (2008)

[7]

Rozen W.M., Garcia-Tutor E., Alonso-Burgos A., Acosta R., Stillaert F., Zubieta J.L., Hamdi M., Whitaker I.S., Ashton M.W., Planning and optimising DIEP flaps with virtual surgery: The Navarra experience, J Plast Reconstr Aesthet Surg, 63, pp. 289-297, (2010)

[8]

Neil-Dwyer J.G., Ludman C.N., Schaverien M., McCulley S.J., Perks A.G., Magnetic resonance angiography in preoperative planning of deep inferior epigastric artery perforator flaps, J Plast Reconstr Aesthet Surg, 62, pp. 1661-1665, (2009)

[9]

Rozen W.M., Stella D.L., Bowden J., Taylor G.I., Ashton M.W., Advances in the pre-operative planning of deep inferior epigastric artery perforator flaps: Magnetic resonance angiography, Microsurgery, 29, pp. 119-123, (2009)

[10]

Masia J., Clavero J.A., Larranaga J.R., Alomar X., Pons G., Serret P., Multidetector-row computed tomography in the planning of abdominal perforator flaps, J Plast Reconstr Aesthet Surg, 59, pp. 594-599, (2006)

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