Planning deep inferior epigastric perforator flaps for breast reconstruction: a comparison between multidetector computed tomography and magnetic resonance angiography

Abstract

Deep inferior epigastric perforator (DIEP) flaps have become the state of the art in breast reconstruction. We compared the diagnostic performance of multidetector computed tomography (CTA) and magnetic resonance angiography (MRA) in DIEP flap planning. Twenty-three women (mean age 48.0years, range 26-72years) underwent preoperative blinded evaluation using 64-slice CTA and 1.5-T MRA. Perforator identification, measurement of their calibre, intramuscular course (IMC), assessment of direct venous connections (DVC) with main superficial veins, superficial venous communications (SVC) between the right and left hemi-abdomen and deep inferior epigastric artery (DIEA) branching type were performed. Surgery was carried out by the same team. Intraoperative findings were the standard of reference. Accuracy in identifying dominant perforators was 91.3% for both techniques and mean error in calibre measurement 1.18 ± 0.35mm for CTA and 1.63 ± 0.39mm for MRA. Accuracy in assessing perforator IMCs was 97.1% for CTA and 88.4% for MRA, DVC 94.4% for both techniques, SVC 91.3% as well, and DIEA branching type 100% for CTA and 91.3% for MRA. Image acquisition and interpretation time was 21 ± 3min for CTA (35 ± 5min for MRA). In a strategy to optimise DIEP flap planning avoiding radiation exposure, MRA can be proposed alternatively to CTA. • Identification of deep inferior epigastric perforators (DIEP) is important before breast reconstruction. • Both CT and MR angiography are accurate in identifying DIEA perforator branches. • CTA and MRA are equivalent in demonstrating perforator-venous connections. • MRA can be proposed as an alternative to CTA in DIEP planning.