title: Preoperative vascular mapping for facial allotransplantation: four-dimensional computed tomographic angiography versus magnetic resonance angiography.
abstract: BACKGROUND
  Facial allotransplantation requires a detailed arterial and venous assessment for surgical planning. Target vessels are often depleted by multiple reconstructive attempts or the severe facial injury itself. The purpose of this study was to retrospectively compare the diagnostic performance of computed tomography and magnetic resonance angiography in the preoperative assessment.
  
  
  METHODS
  Four-dimensional (three spatial planes plus time) computed tomographic and magnetic resonance images including 126 potential vessels (76 arteries and 50 veins) from five candidates were analyzed independently by two radiologists using a four-point image quality scale. Computed tomographic versus magnetic resonance image quality was compared directly, using a computed tomographic angiography consensus read as reference standard. Vessels with metal artifact on magnetic resonance imaging, computed tomography, or both underwent separate analyses to determine the impact of metal implants on image quality.
  
  
  RESULTS
  Considering all 126 vessels, the mean computed tomographic image quality was superior to that of magnetic resonance angiography. When considering individual vessels, all except for major neck vessels were better visualized by computed tomography. Images of 26 vessels were degraded by metal artifact; magnetic resonance image quality was inferior for those vessels. Considering images of major vessels with no metal artifact, there was no significant mean image quality difference between computed tomography and magnetic resonance imaging.
  
  
  CONCLUSIONS
  Computed tomographic angiography should be used as the first-choice modality for preoperative imaging of facial transplant patients because, when compared with magnetic resonance imaging, the visualization of small vessels is far superior and images have fewer artifacts.
  
  
  METHODS
  Diagnostic, II.
authors.affiliation: Boston, Mass. From the Applied Imaging Science Laboratory, Department of Radiology, and the Department of Plastic and Reconstructive Surgery, Brigham and Women's Hospital.
authors.forename: Shigeyoshi
authors.initials: S
authors.lastname: Soga
authors.forename: Bohdan
authors.initials: B
authors.lastname: Pomahac
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Mitsouras
authors.forename: Kanako
authors.initials: K
authors.lastname: Kumamaru
authors.forename: Sara L
authors.initials: SL
authors.lastname: Powers
authors.forename: Richard F
authors.initials: RF
authors.lastname: Prior
authors.forename: Jason
authors.initials: J
authors.lastname: Signorelli
authors.forename: Ericka M
authors.initials: EM
authors.lastname: Bueno
authors.forename: Michael L
authors.initials: ML
authors.lastname: Steigner
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Rybicki
mesh_terms: D000328:Adult; D005145:Face / Q000098:blood supply* / Q000601:surgery; D005260:Female; D056973:Four-Dimensional Computed Tomography / Q000379:methods*; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D015588:Observer Variation; D011300:Preoperative Care / Q000379:methods; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012494:Sampling Studies; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D013524:Surgical Flaps / Q000098:blood supply; D014184:Transplantation, Homologous