Chae Michael P, Hunter-Smith David J, Rozen Warren Matthew
1 Department of Surgery, Monash University, Monash Medical Centre, Clayton, Victoria 3168, Australia ; 2 Monash University Plastic and Reconstructive Surgery Group (Peninsula Clinical School), Peninsula Health, Frankston, Victoria 3199, Australia.
Gland Surg. 2015 Apr;4(2):164-78. doi: 10.3978/j.issn.2227-684X.2015.03.06.
The high incidence of breast cancer and growing number of breast cancer patients undergoing mastectomy has led to breast reconstruction becoming an important part of holistic treatment for these patients. In planning autologous reconstructions, preoperative assessment of donor site microvascular anatomy with advanced imaging modalities has assisted in the appropriate selection of flap donor site, individual perforators, and lead to an overall improvement in flap outcomes. In this review, we compare the accuracy of fluorescent angiography, computed tomographic angiography (CTA), and magnetic resonance angiography (MRA) and their impact on clinical outcomes.
A review of the published English literature dating from 1950 to 2015 using databases, such as PubMed, Medline, Web of Science, and EMBASE was undertaken.
Fluorescent angiography is technically limited by its inability to evaluate deep-lying perforators and hence, it has a minimal role in the preoperative setting. However, it may be useful intraoperatively in evaluating microvascular anastomotic patency and the mastectomy skin perfusion. CTA is currently widely considered the standard, due to its high accuracy and reliability. Multiple studies have demonstrated its ability to improve clinical outcomes, such as operative length and flap complications. However, concerns surrounding exposure to radiation and nephrotoxic contrast agents exist. MRA has been explored, however despite recent advances, the image quality of MRA is considered inferior to CTA.
Preoperative imaging is an essential component in planning autologous breast reconstruction. Fluorescent angiography presents minimal role as a preoperative imaging modality, but may be a useful intraoperative adjunct to assess the anastomosis and the mastectomy skin perfusion. Currently, CTA is the gold standard preoperatively. MRA has a role, particularly for women of younger age, iodine allergy, and renal impairment.
乳腺癌的高发病率以及接受乳房切除术的乳腺癌患者数量不断增加，使得乳房重建成为这些患者整体治疗的重要组成部分。在规划自体乳房重建时，使用先进的成像方式对供区微血管解剖结构进行术前评估有助于正确选择皮瓣供区、单个穿支血管，并总体改善皮瓣手术效果。在本综述中，我们比较了荧光血管造影、计算机断层血管造影（CTA）和磁共振血管造影（MRA）的准确性及其对临床结果的影响。
使用PubMed、Medline、Web of Science和EMBASE等数据库，对1950年至2015年发表的英文文献进行综述。
荧光血管造影在技术上受到无法评估深部穿支血管的限制，因此在术前评估中作用极小。然而，它在术中评估微血管吻合通畅性和乳房切除皮肤灌注方面可能有用。CTA目前因其高准确性和可靠性而被广泛视为标准方法。多项研究表明其能够改善临床结果，如手术时长和皮瓣并发症。然而，存在对辐射暴露和肾毒性造影剂的担忧。MRA已得到探索，然而尽管有最新进展，MRA的图像质量仍被认为不如CTA。
术前成像在规划自体乳房重建中是一个重要组成部分。荧光血管造影作为术前成像方式作用极小，但可能是评估吻合和乳房切除皮肤灌注的有用术中辅助手段。目前，CTA是术前的金标准。MRA有其作用，特别是对于年轻女性、碘过敏和肾功能损害的女性。
