Equilibrium-phase high spatial resolution contrast-enhanced MR angiography at 1.5T in preoperative imaging for perforator flap breast reconstruction ABSTRACT Objectives The aim was (I) to evaluate the accuracy of equilibrium-phase high spatial resolution (EP) contrast-enhanced magnetic resonance angiography (CE-MRA) at 1.5T using a blood pool contrast agent for the preoperative evaluation of deep inferior epigastric artery perforator branches (DIEP), and (II) to compare image quality with conventional first-pass CE-MRA. Methods Twenty-three consecutive patients were included. All patients underwent preoperative CE-MRA to determine quality and location of DIEP. First-pass imaging after a single bolus injection of 10 mL gadofosveset trisodium was followed by EP imaging. MRA data were compared to intra-operative findings, which served as the reference standard. Results There was 100% agreement between EP CE-MRA and surgical findings in identifying the single best perforator branch. All EP acquisitions were of diagnostic quality, whereas in 10 patients the quality of the first-pass acquisition was qualified as non-diagnostic. Both signal-and contrast-to-noise ratios were significantly higher for EP imaging in comparison with first-pass acquisitions (p < 0.01). Conclusions EP CE-MRA of DIEP in the preoperative evaluation of patients undergoing a breast reconstruction procedure is highly accurate in identifying the single best perforator branch at 1.5Tesla (T). Besides accuracy, image quality of EP imaging proved superior to conventional first-pass CE-MRA. INTRODUCTION The number of (prophylactic) mastectomies in (the prevention of) breast cancer is increasing, and so is the number of patients that opt for reconstructive breast surgery after mastectomy.1,2,3 Over the last decade, deep inferior epigastric perforator (DIEP) flap procedures have gained considerable support among plastic surgeons as preferred technique for breast reconstruction.4 In contrast to the more conventional transverse rectus abdominis musculocutaneous (TRAM) flap procedure, the DIEP flap procedure uses only subcutaneous abdominal fat, centered around the best single large perforator branch of the deep inferior epigastric artery (DIEA) for the blood supply of the flap. Well-known advantages of perforator flaps include less postoperative pain, less donor site complications and less 114
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