title: Preoperative vascular mapping with multislice CT of deep inferior epigastric artery perforators in planning breast reconstruction after mastectomy.
abstract: OBJECTIVE
  Our aim was to evaluate the usefulness of computed tomography angiography (CTA) in vascular mapping for planning breast reconstruction after mastectomy using a free flap made with the deep inferior epigastric perforators (DIEP).
  
  
  METHODS
  We retrospectively evaluated 41 patients, mean age 57 years, scheduled for mastectomy. CTA was performed with a 64-row scanner (Aquilion 64, Toshiba Medical Systems, Japan), with injection of 100 ml of contrast medium (iomeprol 350 mgI/ml, Bracco, Italy) at 4.5 ml/s. Maximum intensity projection (MIP) and three-dimensional volume-rendering (VR) reconstructions were made to mark perforator positions. Presentation frequency, anatomy and artery opacification quality were evaluated.
  
  
  RESULTS
  DIEP were always depicted (n=81) and subdivided according to Taylor's classification into type I (65%), type II (28%), and type III (7%). We observed a mean of three (range, 1-5) DIEP arteries on the right and two (range, 1-5) on the left side. The superficial inferior epigastric artery (SIEA) was depicted in 6/41 patients, bilaterally in three cases. Opacification was optimal in 30/41 cases, venous contamination due to late arterial phase in eight and low opacification due to early scan in three.
  
  
  CONCLUSIONS
  Studying DIEP with CTA is useful in the surgical planning of breast reconstruction, even though it requires careful optimisation owing to the critical timing of opacification typical of that vascular district.
authors.affiliation: UCO di Radiologia, Dipartimento di Scienze Mediche, Chirurgiche e della Salute, Università degli Studi di Trieste, Ospedale di Cattinara, Strada di Fiume 447, Trieste, Italy. xpelle@gmail.com
authors.forename: A
authors.initials: A
authors.lastname: Pellegrin
authors.forename: T
authors.initials: T
authors.lastname: Stocca
authors.forename: M
authors.initials: M
authors.lastname: Belgrano
authors.forename: M
authors.initials: M
authors.lastname: Bertolotto
authors.forename: F
authors.initials: F
authors.lastname: Pozzi-Mucelli
authors.forename: Z
authors.initials: Z
authors.lastname: Marij Arnež
authors.forename: M A
authors.initials: MA
authors.lastname: Cova
mesh_terms: D001943:Breast Neoplasms / Q000601:surgery*; D003287:Contrast Media; D019074:Epigastric Arteries / Q000000981:diagnostic imaging* / Q000637:transplantation; D005260:Female; D058752:Free Tissue Flaps / Q000098:blood supply*; D006801:Humans; D021621:Imaging, Three-Dimensional; D007479:Iopamidol / Q000031:analogs & derivatives; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy; D008875:Middle Aged; D061525:Perforator Flap / Q000098:blood supply*; D011300:Preoperative Care; D011857:Radiographic Image Interpretation, Computer-Assisted; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media; C057937:iomeprol; D007479:Iopamidol