Prone liver phase MRA demonstrates improved intramuscular vascular detail compared to CTA in preoperative perforator mapping for free autologous abdominally-based breast reconstruction
| Autor: | Chris A. Campbell, J. Bryce Olenczak, Maryann Martinovic, Justin P. Martin |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
medicine.diagnostic_test
business.industry Vascular anatomy Radiography Umbilicus (mollusc) Deep Inferior Epigastric Artery General Medicine eye diseases nervous system diseases Radiation exposure medicine Breast MRI cardiovascular diseases Nuclear medicine business Venous anatomy Breast reconstruction |
| Zdroj: | Annals of Breast Surgery. 2:12-12 |
| ISSN: | 2616-2776 |
| DOI: | 10.21037/abs.2018.06.02 |
| Popis: | Background: MRA and CTA are both used to evaluate perforator anatomy in preparation for autologous breast reconstruction. While CTA is most commonly performed, prone liver phase MRA (PLP-MRA) can be performed concomitantly with breast MRI to assess arterial and venous anatomy while providing superior discrimination of vascular anatomy. Methods: Consecutive patients with planned free autologous abdominally-based breast reconstruction were prospectively randomized to undergo preoperative perforator mapping with CTA or PLP-MRA. Imaging was used to predict whether a deep inferior epigastric artery perforator flap (DIEP) or muscle-sparing-2-TRAM (MS2-TRAM) would be performed. Paired radiographic and blinded intra-operative measurements of perforator location relative to the umbilicus, intramuscular pedicle length and pedicle position relative to the semilunar line were compared by paired Wilcoxon rank sum test. Results: The type of flap performed was accurately predicted in all cases from PLP-MRA or CTA. Both PLP-MRA and CTA accurately predicted perforator location (48 hemi-abdomens) and distance from semi-lunar line (30 hemi-abdomens). PLP-MRA was superior to CTA in accurately predicting intra-muscular pedicle length (P 2 mm in diameter. Conclusions: PLP-MRA offers superior accuracy in predicting intramuscular pedicle length compared to CTA while maintaining accuracy in determining perforator location and pedicle position to assist with flap design. This PLP-MRA protocol can be performed concomitantly with pre-operative breast MRI in select patients to avoid multiple imaging modalities and avoid radiation exposure. |
| Databáze: | OpenAIRE |
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