Yang Xiangyu, Miller Michael J, Friel Harry T, Slijepcevic Allison, Knopp Michael V
From the *Department of Radiology, The Ohio State University Wexner Medical Center; †Wright Center of Innovation in Biomedical Imaging, The Ohio State University; ‡Department of Plastic Surgery, The Ohio State University Wexner Medical Center, Columbus; §Philips Healthcare, Highland Heights; and ∥The Ohio State University Wexner Medical Center, Columbus, OH.
Invest Radiol. 2017 Jun;52(6):334-342. doi: 10.1097/RLI.0000000000000348.
The aim of this study was to demonstrate the feasibility of in vivo perforator visualization by a newly proposed magnetic resonance-based perforator phase contrast angiography (pPCA) technique for deep inferior epigastric perforator (DIEP) flap surgery and to prospectively compare its image quality and clinical value with computed tomographic angiography (CTA), the state-of-the-art perforator imaging technique.
Institutional review board approval and informed consent were obtained. DIEP pPCA and CTA data were acquired in 10 female patients before DIEP flap surgery. Image findings were compared between the two techniques and with literature reports.
The overall image quality is negatively correlated with patient BMI for CTA, but positively correlated with BMI for pPCA. Compared with CTA, pPCA has significantly better image quality (P = 0.005), signal-to-noise ratio (P < 0.001), and contrast-to-noise ratio (perforator-to-muscle, P < 0.001; perforator-to-fat, P = 0.014). It also has preferable clinical value ratings, although not statistically significant (P = 0.388). There is a good agreement (84%) between perforators detected by pPCA and CTA. Perforator location deviations between pPCA and CTA are compatible with the precision required for plastic surgery. Perforator size measured by pPCA seems to be more accurate than CTA, as it is 0.8 ± 0.3 mm smaller (P < 0.001), consistent with the reported 0.5 to 1.2 mm overestimation by CTA. There is no significant difference in perforator intramuscular course assessment (P = 0.415).
The developed magnetic resonance-based pPCA technique presents superior image quality, better vessel contrast, and more accurate perforator anatomy than the x-ray-based CTA. pPCA has the potential to emerge as the preferred preoperative planning tool for perforator flap reconstructive surgery.
本研究旨在通过一种新提出的基于磁共振的穿支血管相位对比血管造影（pPCA）技术，证明其在体内可视化腹壁下深动脉穿支（DIEP）皮瓣手术穿支血管的可行性，并前瞻性地将其图像质量和临床价值与计算机断层血管造影（CTA）这一最先进的穿支血管成像技术进行比较。
获得机构审查委员会批准并取得患者知情同意。在10例女性患者进行DIEP皮瓣手术前，采集其DIEP pPCA和CTA数据。比较两种技术的图像表现，并与文献报道进行对比。
CTA的总体图像质量与患者体重指数呈负相关，而pPCA的总体图像质量与体重指数呈正相关。与CTA相比，pPCA具有显著更好的图像质量（P = 0.005）、信噪比（P < 0.001）和对比噪声比（穿支血管与肌肉，P < 0.001；穿支血管与脂肪，P = 0.014）。其临床价值评分也较好，尽管无统计学意义（P = 0.388）。pPCA和CTA检测到的穿支血管之间有良好的一致性（84%）。pPCA和CTA之间穿支血管位置偏差符合整形手术所需的精度。pPCA测量的穿支血管大小似乎比CTA更准确，比CTA小0.8±0.3 mm（P < 0.001），这与报道的CTA高估0.5至1.2 mm一致。穿支血管肌肉内走行评估无显著差异（P = 0.415）。
所开发的基于磁共振的pPCA技术比基于X线的CTA具有更高的图像质量、更好的血管对比度和更准确的穿支血管解剖结构。pPCA有可能成为穿支皮瓣重建手术首选的术前规划工具。
