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

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