title: Contrast-enhanced magnetic resonance angiography for preoperative imaging in DIEP flap breast reconstruction.
abstract: BACKGROUND
  Contrast-enhanced magnetic resonance angiography has been shown to be very accurate for identifying the perforator size, location, and intramuscular course, and the associated venous system, without exposing the patient to ionizing radiation. This study reports the authors' experience using this imaging modality in a large patient series.
  
  
  METHODS
  A retrospective review of patients who had undergone preoperative contrast-enhanced magnetic resonance angiography followed by free abdominal flap breast reconstruction was conducted. The results of imaging were compared with intraoperative findings, and surgical outcomes were compared with scan data. The results were compared with control data in patients who did not undergo presurgical imaging.
  
  
  RESULTS
  One hundred thirty-two patients underwent contrast-enhanced magnetic resonance angiography presurgical imaging, and the results were compared with 84 controls. The imaging was found to be accurate for evaluating the perforator anatomy for free abdominal flap planning, with a high concordance between imaging and intraoperative findings. Without presurgical angiography, the ratio of deep inferior epigastric perforator (DIEP) flap-to-free transverse rectus abdominis musculocutaneous flap harvest was 0.9:1; with presurgical imaging, the ratio was 1.6:1 (p < 0.05). With presurgical angiography, there was a mean reduction in operating time of 26 minutes for unilateral DIEP flap harvest and 40 minutes for bilateral harvest, although these values were not significant. There was a significant reduction in the partial flap failure rate with preoperative imaging.
  
  
  CONCLUSIONS
  Presurgical imaging using contrast-enhanced magnetic resonance angiography demonstrates a high concordance with intraoperative findings. In this series, the percentage of flaps that were raised as DIEP flaps was significantly increased in patients who underwent preoperative imaging, and the partial flap failure rate was significantly reduced.
  
  
  METHODS
  : Therapeutic, III.(Figure is included in full-text article.).
authors.affiliation: Nottingham, United Kingdom From the Departments of Plastic Surgery and Radiology, Nottingham University Hospitals NHS Trust.
authors.forename: Mark V
authors.initials: MV
authors.lastname: Schaverien
authors.forename: Catherine N
authors.initials: CN
authors.lastname: Ludman
authors.forename: Jason
authors.initials: J
authors.lastname: Neil-Dwyer
authors.forename: Graeme B
authors.initials: GB
authors.lastname: Perks
authors.forename: Nadeem
authors.initials: N
authors.lastname: Akhtar
authors.forename: Jeremy N
authors.initials: JN
authors.lastname: Rodrigues
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Benetatos
authors.forename: Anna
authors.initials: A
authors.lastname: Raurell
authors.forename: Tuabin
authors.initials: T
authors.lastname: Rasheed
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: McCulley
mesh_terms: D000328:Adult; D000368:Aged; D000792:Angiography / Q000379:methods*; D016022:Case-Control Studies; D003287:Contrast Media; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D011300:Preoperative Care; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000098:blood supply*; D055815:Young Adult
chemical_list: D003287:Contrast Media