Abstract
ObjectivesThe aim was (i) to evaluate the accuracy of equilibrium-phase high spatial resolution (EP) contrast-enhanced magnetic resonance angiography (CE-MRA) at 1.5T using a blood pool contrast agent for the preoperative evaluation of deep inferior epigastric artery perforator branches (DIEP), and (ii) to compare image quality with conventional first-pass CE-MRA.MethodsTwenty-three consecutive patients were included. All patients underwent preoperative CE-MRA to determine quality and location of DIEP. First-pass imaging after a single bolus injection of 10 mL gadofosveset trisodium was followed by EP imaging. MRA data were compared to intra-operative findings, which served as the reference standard.ResultsThere was 100% agreement between EP CE-MRA and surgical findings in identifying the single best perforator branch. All EP acquisitions were of diagnostic quality, whereas in 10 patients the quality of the first-pass acquisition was qualified as non-diagnostic. Both signal- and contrast-to-noise ratios were significantly higher for EP imaging in comparison with first-pass acquisitions (p<0.01).ConclusionsEP CE-MRA of DIEP in the preoperative evaluation of patients undergoing a breast reconstruction procedure is highly accurate in identifying the single best perforator branch at 1.5Tesla (T). Besides accuracy, image quality of EP imaging proved superior to conventional first-pass CE-MRA.
Highlights
The number of mastectomies in breast cancer is increasing, and so is the number of patients that opt for reconstructive breast surgery after mastectomy [1,2,3]
Several authors have demonstrated that MR angiography can be used in preoperative imaging of the perforator branches of the deep inferior epigastric artery (DIEA) [5,6,8,15,16]
Considering the small size of DIEA perforator branches we wondered whether it was possible to obtain high spatial resolution equilibrium-phase (EP) images with improved resolution compared to first-pass acquisitions using a recently described new intravascular contrast agent, gadofosveset trisodium [17,18]
Summary
The number of (prophylactic) mastectomies in (the prevention of) breast cancer is increasing, and so is the number of patients that opt for reconstructive breast surgery after mastectomy [1,2,3]. Disadvantages of the DIEP procedure, on the other hand, include difficulties in harvesting the flap, resulting in considerably longer dissection times, and the fact that long-term results depend heavily on the quality of the perforator branch supplying the flap. Several studies have been performed using state-of-the-art 3T hardware, instead of the more widely available 1.5T magnetic resonance angiography (MRI) systems [5,6,8,15,16], and most of these studies have employed conventional extracellular contrast agents in combination with first-pass imaging to visualize DIEA perforator branches. Considering the small size of DIEA perforator branches we wondered whether it was possible to obtain high spatial resolution equilibrium-phase (EP) images with improved resolution compared to first-pass acquisitions using a recently described new intravascular contrast agent, gadofosveset trisodium [17,18]. Blood pool agents have important benefits over conventional small-sized extracellular agents in CE-MRA, such as the lengthened imaging window and the relatively large R1 [19], both allowing longer acquisition times, enabling data acquisition at a very high resolution and with very high accuracy
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