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Optimising the preoperative planning of deep inferior epigastric perforator flaps for breast reconstruction

  • Vascular-Interventional
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

Preoperative planning of deep inferior epigastric perforator (DIEP) flaps has become increasingly important in radiology services as multidetector CT angiography (CTA) has been proven to be the technique of choice. We aim to optimise the process, checking the value of the “Navarra criteria,” assessing radiological and surgical concordance.

Methods

Preoperative CTA was obtained in 105 DIEP flaps involving 101 women (mean age 49.1 years). A main perforator pedicle and an alternative were chosen, applying a modification of the “Navarra criteria,” assessing the correlation between the main perforator chosen by the radiologist and the one that was ultimately used to perform the flap using the Kappa index.

Results

In 100 of the 105 DIEP flaps (95.2 %), the perforator pedicles chosen were ultimately used to raise the flap. Four of the perforator pedicles that were not used were dismissed due to avoidable errors in the radiological approach. Concordance was very high, with a Kappa index of 0.93 (95 % CI: 0.87–0.99). CT room time was less than 12 minutes, and reading time was 10 minutes.

Conclusions

The application of the “Navarra criteria” in preoperative planning of DIEP flaps improves radiological and surgical concordance as well as the reading process.

Key Points

• DIEP flap is one of the best techniques for breast reconstruction.

• Preoperative planning is essential in DIEP flaps.

• CTA is the best option for the preoperative planning of DIEP flaps.

• “Navarra criteria” allow radiologists to choose the best perforator to form flaps.

• Modified “Navarra criteria” improves radiological and surgical concordance.

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Abbreviations

CDS:

Colour Doppler sonography

CTA:

Multidetector computed tomography angiography

DIEA:

Deep inferior epigastric artery

DIEP:

Deep inferior epigastric perforator

MIP:

Maximum intensity projection

MPR:

Multiplanar reconstruction

MRA:

Magnetic resonance angiography

SIEA:

Superficial inferior epigastric artery

TRAM:

Transverse rectus abdominis myocutaneous

VR:

Volume rendering

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Acknowledgements

The scientific guarantor of this publication is Dr. Emilio Garcia-Tutor (consulta@drgarciatutor.es). The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors, Gil Rodríguez Caravaca, has significant statistical expertise. Institutional Review Board approval was obtained, as it is an observational study, which does not change the usual diagnosis and treatment sequences. All of the information and images of patients used for the study was anonymous. Written informed consent was obtained from all subjects (patients) in this study. Some study subjects have been previously reported as a poster in ECR 2013 with DOI: 10.1594/ecr2013/C-1030. Methodology: prospective, observational, performed at one institution.

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Authors and Affiliations

  1. Department of Radiology, Hospital Universitario de Torrejon, C/Mateo Inurria s/n. C.P.28550, Torrejon de Ardoz, Madrid, Spain

    Miguel Casares Santiago

  2. Hospital Universitario Guadalajara, Guadalajara, Spain

    Emilio García-Tutor, Julián del Cerro González & Léa Marie Klein

  3. Hospital Universitario Fundación Alcorcón, Madrid, Spain

    Gil Rodríguez Caravaca

  4. Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain

    Alberto Alonso-Burgos

Authors
  1. Miguel Casares Santiago
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  2. Emilio García-Tutor
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  3. Gil Rodríguez Caravaca
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  4. Julián del Cerro González
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  5. Léa Marie Klein
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  6. Alberto Alonso-Burgos
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Correspondence to Miguel Casares Santiago.

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Casares Santiago, M., García-Tutor, E., Rodríguez Caravaca, G. et al. Optimising the preoperative planning of deep inferior epigastric perforator flaps for breast reconstruction. Eur Radiol 24, 2097–2108 (2014). https://doi.org/10.1007/s00330-014-3243-5

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  • DOI: https://doi.org/10.1007/s00330-014-3243-5

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