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Chapter 7 The location at which these perforators penetrated the rectus fascia with respect to the center of the umbilicus was noted as x,y-coordinates with the center of the umbilicus being the origin (0,0). The total number of perforator branches visualized by both first-pass and equilibrium-phase imaging were determined within a region extending from 5 cm cranial to 10 cm caudal to the umbilicus. Comparison of CE-MRA and intraoperative findings DIEP flap dissection was performed by a team of three plastic surgeons. Surgeons noted the location of the single best perforator they found during surgery, within the region that was evaluated with MRA. A handheld device ultrasonography and visual/manual inspection were used to identify perforator branches during surgery. After surgery, CE-MRA and intraopera- tive findings were compared. Data were considered concordant if differences between MRA and intraoperative findings were less than 1 cm in cranio- caudal and/or left-right direction. Statistical analysis An independent-samples t-test was performed to test the significance of differences in image quality between first-pass and equilibrium-phase CE-MRA and the differences in total number of perforator branches between first-pass and equilibrium-phase CE-MRA and intraoperative findings. RESULTS Subjects All included patients underwent MRA without experiencing side effects or adverse events. In twenty-three patients 36 DIEP flaps were successfully dissected. Ten patients underwent unilateral flap dissection, whereas in 13 patients a bilateral flap dissection was performed. Diagnostic accuracy of equilibrium-phase high spatial resolution imaging Equilibrium-phase high spatial resolution acquisitions predicted the location of the single best perforator accurately in all cases, i.e. in 36/36 perfo- rators (100% of the patients). The locations of the perforator branches used for surgery are graphically presented in figure 7.1. The average location of the single best perforator found during surgery and with equilibrium-phase imaging was located 3.0 ± 1.2 cm (mean ± SD) lateral and 0.6 ± 1.2 cm caudal in respect with the umbilicus (figure 7.1). There was no significant difference in distance to the umbilicus for left and right sided perforator branches (p = 0.15). 119


5. lay-out phd DEFINITIEF_digitaal2
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