Alessandro Cina MD, Presenter: Nothing to Disclose

Marzia Salgarello MD, Abstract Co-Author: Nothing to Disclose

Liliana Barone Adesi, Abstract Co-Author: Nothing to Disclose

Lorenzo Bonomo MD, Abstract Co-Author: Nothing to Disclose

Multidetector CT (MDCT) has been recently proposed as accurate tool for preoperative mapping of deep inferior epigastric artery perforators (DIEP) employed for breast reconstruction. No data are still available to compare MDCT with the established standard technique: color-Doppler US (CDUS). Purpose of this paper are: 1) To briefly describe the DIEP surgery and the role of diagnostic imaging; 2) to assess the accuracy of multidetector CT (MDCT) vs color-Doppler US for the identification of the DIEP; and 3) to evaluate the time-cost of both techniques.

40 women underwent 16-rows MDCT and CDUS for planning DIEP surgery. Blind evaluation of MDCT and CDUS was performed before surgery. Surgical findings are employed as gold standard. Accuracy of MDCT vs CDUS was assessed for: detection (presence and measure) of the dominant and three best perforators; mapping of perforators by a virtual coordinates system;  evaluation of the lenght of the intramuscular course of perforators (<10 mm; 11-20 mm; >20 mm); detection of superficial venous communications between right and left side of infraumbelical region.

The best perforator, effectively employed for surgical reconstruction, was identified in 38/40 cases (95%) by CDUS and in 37/40 (92.5%) by MDCT. Perforators evaluated at surgery as adequate for reconstruction were correctly identified in 106/118 cases by CDUS (90%) and in 112/118 cases (95%) by MDCT. The lenght of intramuscular course of the dominant perforators was correctly assessed by MDCT in 38/40 cases (95%) and by CDUS in 35/40 cases(87%).  Venous superficial communications between right and left side were correctly identified in 29/30 patients (97%) by MDCT and in 25/30 by CDUS (83%).  Mean time for examination and mapping was 22 min for CDUS and 23 for MDCT.

Both techniques resulted adequate for planning DIEP surgery. Global accuracy of MDCT is high, although not superior to CDUS for detection of the best perforator. CDUS can be still employed as reference technique, if an expert operator is available. If a dedicated US operator is not available or if CDUS is doubtful or panoramic anatomical information are required, MDCT can be recommended.

MDCT is equal to CDUS for select the dominant perforator for DIEP flaps. MDCT have some advantages for the evaluation of intramuscular course of perforators and can be proposed in case of doubt CDUS.

Cina, A, Salgarello, M, Barone Adesi, L, Bonomo, L, Perspective Evaluation of Multidetector CT vs Color Doppler US for Planning Breast Reconstructive Surgery with Deep Inferior Epigastric Artery Perforators.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6010222.html