Nidhi Sharma MD, Presenter: Nothing to Disclose

Melanie Chellman-Jeffers MD, Abstract Co-Author: Nothing to Disclose

Graham S. Schwarz, Abstract Co-Author: Nothing to Disclose

Noninvasive angiographic imaging modalities have been increasingly used to aid in flap design and perforator vessel mapping in free flap breast reconstruction. Few studies, however, have addressed recipient vessel mapping. Standard breast MRI is an integral tool for oncologic treatment planning at Cleveland Clinic. It is performed as part of our institutional protocol to evaluate extent of disease, and is an increasingly prominent component of national treatment guidelines. A majority of our patients obtain breast MRI prior to mastectomy and breast reconstruction. The aim of this study is to evaluate how intraoperative internal mammary (IMA/IMV) vessel measurements correlate with breast MRI measured vessel caliber.

Following IRB approval, IMA and IMV diameters were prospectively measured intraoperatively at anticipated microanastomotic sites with micro-calipers just prior to division of the vessels. An anatomic reference point was established. T1-weighted, contrast enhanced, and coronal STIR sequences were obtained on a 1.5T Siemens MRI unit with a dedicated breast coil and images reviewed on an AGFA workstation. Using standard workstation measurement tool software a resident and a senior breast radiologist independently noted vessel diameters at corresponding anatomic reference points. Correlation models evaluating intraoperative and MRI measurements were developed and analyzed for significance using methods of repeated measures mixed models.   

Thirty one vessels were evaluated (13 arteries, 18 veins) in 8 consecutive women undergoing free flap breast reconstruction (5 bilateral, 3 unilateral). Intraoperative mean IMA diameter was 2.8 mm (range 2 - 4 mm), mean IMV1 diameter was 3 mm (range 2 - 4.5 mm) and mean IMV2 diameter was 2.1 mm (range 1.5 - 3 mm). Respective MRI mean diameters were: IMA 3 mm (range 2.1 - 4 mm), IMV1 2.8 mm (range 2.2 – 4.8 mm) and IMV2 2.3 mm (range 1.6 – 2.9 mm). Significant correlation existed between intraoperative and MRI measurements for both arteries and veins (arteries r= 0.77, p=0.0056 and veins r=0.7, p=0.0045).  

Breast MRI measurements correlate well with actual IMA and IMV diameters, thereby, allowing vessel size prediction as well as anatomic localization. 

In centers using this modality, standard Breast MRI may be a useful adjunct in free flap planning without adding to cost of care or subjecting patients to ionizing radiation. 

Sharma, N, Chellman-Jeffers, M, Schwarz, G, Utility of Breast MRI in Preoperative Planning for Free Flap Breast Reconstruction.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13022963.html