Abstract
IntroductionThe aim of the study was to compare the detectability of neck vessels with contrast enhanced magnetic resonance angiography (MRA) in the setting of a whole-body MRA and multislice computed tomography angiography (CTA) for preoperative vascular mapping of head and neck.MethodsIn 20 patients MRA was performed prior to microvascular reconstruction of the mandible with osteomyocutaneous flaps. CTA of the neck served as the method of reference.1.5 T contrast enhanced magnetic resonance angiograms were acquired to visualize the vascular structures of the neck in the setting of a whole-body MRA examination. 64-slice spiral computed tomography was performed with a dual-phase protocol, using the arterial phase images for 3D CTA reconstruction. Maximum intensity projection was employed to visualize MRA and CTA data. To retrieve differences in the detectability of vessel branches between MRA and CTA, a McNemar test was performed.ResultsAll angiograms were of diagnostic quality. There were no statistically significant differences between MRA and CTA for the detection of branches of the external carotid artery that are relevant host vessels for microsurgery (p = 0.118). CTA was superior to MRA if all the external carotid artery branches were included (p < 0.001).ConclusionsMRA is a reliable alternative to CTA in vascular mapping of the cervical vasculature for planning of microvascular reconstruction of the mandible. In the setting of whole-body MRA it could serve as a radiation free one-stop-shop tool for preoperative assessment of the arterial system, potentially covering both, the donor and host site in one single examination.
Highlights
The aim of the study was to compare the detectability of neck vessels with contrast enhanced magnetic resonance angiography (MRA) in the setting of a whole-body MRA and multislice computed tomography angiography (CTA) for preoperative vascular mapping of head and neck
With recurrent tumor disease, the mainstem of the external carotid artery was occluded on both sides of the neck, in four patients this vessel was not visualized on one side because of previous surgery
Nonselective digital subtraction angiography (DSA) of the supraaortic vessels is insufficient to display exactly the branches of the external carotid artery; selective catheter angiography is the modality of choice [6], providing an exquisite spatial resolution and the ability to obtain dynamic information
Summary
The aim of the study was to compare the detectability of neck vessels with contrast enhanced magnetic resonance angiography (MRA) in the setting of a whole-body MRA and multislice computed tomography angiography (CTA) for preoperative vascular mapping of head and neck. Microvascular grafts are often required to cover large resection defects following oral tumor surgery or osteoradionecrosis of the mandible. Their use has been well established in oral and maxillofacial surgery. Contrast enhanced magnetic resonance angiography (MRA) is an ideal non-invasive tool without radiation exposure for whole-body evaluation of atherosclerotic disease. Whole-body MRA has been introduced recently for presurgical planning of microvascular (e.g. fibular) free-flap head and neck reconstructions [5] and could serve as a potential one-stop shop tool for preoperative assessment of the arterial system, covering both the donor and host site
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