Article Abstract

Prone liver phase MRA demonstrates improved intramuscular vascular detail compared to CTA in preoperative perforator mapping for free autologous abdominally-based breast reconstruction

Authors: J. Bryce Olenczak, Maryann Martinovic, Justin P. Martin, Chris A. Campbell


Background: MRA and CTA are both used to evaluate perforator anatomy in preparation for autologous breast reconstruction. While CTA is most commonly performed, prone liver phase MRA (PLP-MRA) can be performed concomitantly with breast MRI to assess arterial and venous anatomy while providing superior discrimination of vascular anatomy.
Methods: Consecutive patients with planned free autologous abdominally-based breast reconstruction were prospectively randomized to undergo preoperative perforator mapping with CTA or PLP-MRA. Imaging was used to predict whether a deep inferior epigastric artery perforator flap (DIEP) or muscle-sparing-2-TRAM (MS2-TRAM) would be performed. Paired radiographic and blinded intra-operative measurements of perforator location relative to the umbilicus, intramuscular pedicle length and pedicle position relative to the semilunar line were compared by paired Wilcoxon rank sum test.
Results: The type of flap performed was accurately predicted in all cases from PLP-MRA or CTA. Both PLP-MRA and CTA accurately predicted perforator location (48 hemi-abdomens) and distance from semi-lunar line (30 hemi-abdomens). PLP-MRA was superior to CTA in accurately predicting intra-muscular pedicle length (P<0.05). PLP-MRA allowed venous and arterial contrast to be separately identified in perforators >2 mm in diameter.
Conclusions: PLP-MRA offers superior accuracy in predicting intramuscular pedicle length compared to CTA while maintaining accuracy in determining perforator location and pedicle position to assist with flap design. This PLP-MRA protocol can be performed concomitantly with pre-operative breast MRI in select patients to avoid multiple imaging modalities and avoid radiation exposure.