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Preoperative vascular mapping with multislice CT of deep inferior epigastric artery perforators in planning breast reconstruction after mastectomy

Mapping vascolare pre-operatorio con TC multistrato dei rami perforanti dell’arteria epigastrica inferiore in previsione di ricostruzione mammaria post-mastectomia

  • Abdominal Radiology / Radiologia Addominale
  • Published:
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Abstract

Purpose

Our aim was to evaluate the usefulness of computed tomography angiography (CTA) in vascular mapping for planning breast reconstruction after mastectomy using a free flap made with the deep inferior epigastric perforators (DIEP).

Materials and methods

We retrospectively evaluated 41 patients, mean age 57 years, scheduled for mastectomy. CTA was performed with a 64-row scanner (Aquilion 64, Toshiba Medical Systems, Japan), with injection of 100 ml of contrast medium (iomeprol 350 mgI/ml, Bracco, Italy) at 4.5 ml/s. Maximum intensity projection (MIP) and threedimensional volume-rendering (VR) reconstructions were made to mark perforator positions. Presentation frequency, anatomy and artery opacification quality were evaluated.

Results

DIEP were always depicted (n=81) and subdivided according to Taylor’s classification into type I (65%), type II (28%), and type III (7%). We observed a mean of three (range, 1–5) DIEP arteries on the right and two (range, 1–5) on the left side. The superficial inferior epigastric artery (SIEA) was depicted in 6/41 patients, bilaterally in three cases. Opacification was optimal in 30/41 cases, venous contamination due to late arterial phase in eight and low opacification due to early scan in three.

Conclusions

Studying DIEP with CTA is useful in the surgical planning of breast reconstruction, even though it requires careful optimisation owing to the critical timing of opacification typical of that vascular district.

Riassunto

Obiettivo

Scopo del nostro lavoro è stato valutare l’apporto dell’angio-tomografia computerizzata (angio-TC) nel mapping vascolare per la pianificazione di intervento di ricostruzione mammaria post-mastectomia mediante l’utilizzo di lembo libero confezionato con perforanti dell’arteria epigastrica inferiore profonda (DIEP).

Materiali e metodi

Sono state valutate retrospettivamente 41 pazienti, età media 57 anni, indirizzate alla mastectomia. Le angio-TC sono state effettuate con una TC a 64-detettori durante l’iniezione di 100 ml di mezzo di contrasto (MdC) con flusso di 4,5 ml/s. Sono state effettuate ricostruzioni a proiezione di massima intensità (MIP) e 3D-volume rendering (VR) per individuare le arterie perforanti, delle quali si è valutata la frequenza, l’anatomia e la qualità di opacizzazione.

Risultati

Le arterie epigastriche inferiori profonde sono state sempre visualizzate (n=81), classificate secondo Taylor in: tipo I 65%, tipo II 28%, tipo III 7%. Il numero medio di DIEP riscontrato è stato di 3 (range 1–5) a destra e di 2 (range 1–5) a sinistra. L’arteria epigastrica inferiore superficiale (SIEA) è stata visualizzata in 6 pazienti su 41, bilateralmente in 3 casi. La qualità dell’opacizzazione vascolare è stata ottimale in 30 casi su 41, mentre si è registrata sovrapposizione venosa per fase arteriosa tardiva in 8 indagini su 41 ed opacizzazione subottimale per scansione precoce in 3 casi.

Conclusioni

Lo studio dei vasi perforanti con angio-TC rappresenta un utile supporto per la pianificazione dell’intervento di ricostruzione mammaria, ma richiede un’ottimizzazione dell’indagine per la tempistica di opacizzazione critica di tali vasi.

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Authors and Affiliations

  1. UCO di Radiologia, Dipartimento di Scienze Mediche, Chirurgiche e della Salute, Università degli Studi di Trieste, Ospedale di Cattinara, Strada di Fiume 447, Trieste, Italy

    A. Pellegrin, T. Stocca, M. Belgrano, M. Bertolotto, F. Pozzi-Mucelli & M. A. Cova

  2. UCO di Chirurgia Plastica, Dipartimento di Scienze Mediche, Chirurgiche e della Salute, Università degli Studi di Trieste, Ospedale di Cattinara, Strada di Fiume 447, Trieste, Italy

    Z. Marij Arnež

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  1. A. Pellegrin
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  2. T. Stocca
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  3. M. Belgrano
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  4. M. Bertolotto
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  5. F. Pozzi-Mucelli
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  6. Z. Marij Arnež
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  7. M. A. Cova
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Correspondence to A. Pellegrin.

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Pellegrin, A., Stocca, T., Belgrano, M. et al. Preoperative vascular mapping with multislice CT of deep inferior epigastric artery perforators in planning breast reconstruction after mastectomy. Radiol med 118, 732–743 (2013). https://doi.org/10.1007/s11547-012-0887-5

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  • DOI: https://doi.org/10.1007/s11547-012-0887-5

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