Renzulli Matteo, Clemente Alfredo, Brocchi Stefano, Gelati Chiara, Zanotti Simone, Pizzi Carmine, Tassone Daniela, Cappabianca Salvatore, Cipriani Riccardo, Golfieri Rita
Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italia.
Radiology and Radiotherapy Unit, Department of Precision Medicine, University of Campania "L. Vanvitelli," Naples, Italy.
Acta Radiol. 2021 Oct;62(10):1283-1289. doi: 10.1177/0284185120963899. Epub 2020 Oct 18.
Deep inferior epigastric perforator (DIEP) flap reconstruction is the gold standard reconstructive technique for women undergoing breast cancer surgery. A preoperative computed tomography angiography (CTA)-dedicated protocol and 3D reconstructions are mandatory for correct surgical planning.
To evaluate the diagnostic performance of a new preoperative CTA protocol and a new reconstruction method in the assessment of DIEP technique.
A total of 263 women (median age 49 years, age range 26-73 years) underwent preoperative CTA examination before DIEP flap breast reconstruction. A CTA-dedicated protocol followed by 3D-reconstructions were performed. Identification, branching pattern, and caliber at origin were assessed for each perforator. Intraoperative findings were the standard of reference. The sensitivity, positive predictive value, and diagnostic accuracy of the preoperative CTA protocol were calculated.
In 255/263 (97%) patients, the dominant perforators assessed by CTA resulted adequate for surgical reconstruction. In 260/263 (99%) cases, the imaging localization of the dominant perforators corresponded with those seen intraoperatively (mean errors ≤1 cm). The preoperative CTA imaging sensitivity, positive predictive value, and diagnostic accuracy in determining the localization of perforators were 99% (95% CI 98-100), 100% and 99% (95% CI 98-100), respectively. No statistically significant differences were found between the CTA findings and the surgical findings for the assessment of branching pattern and caliber of the dominant perforators ( < 0.001).
The present protocol has demonstrated high accuracy in the CTA imaging assessment of the perforators before DIEP flap reconstruction with high reproducibility between CT and surgical findings.
腹壁下深动脉穿支（DIEP）皮瓣重建术是乳腺癌手术女性患者的金标准重建技术。术前计算机断层血管造影（CTA）专用方案及三维重建对于正确的手术规划必不可少。
评估一种新的术前CTA方案及一种新的重建方法在评估DIEP技术中的诊断性能。
263例女性患者（中位年龄49岁，年龄范围26 - 73岁）在进行DIEP皮瓣乳房重建术前接受了CTA检查。采用CTA专用方案并进行三维重建。评估每个穿支的识别、分支模式及起始处管径。术中发现为参考标准。计算术前CTA方案的敏感性、阳性预测值及诊断准确性。
在255/263（97%）例患者中，CTA评估的主要穿支适合手术重建。在260/263（99%）例病例中，主要穿支的影像定位与术中所见相符（平均误差≤1 cm）。术前CTA影像在确定穿支定位方面的敏感性、阳性预测值及诊断准确性分别为99%（95%CI 98 - 100）、100%及99%（95%CI 98 - 100）。在评估主要穿支的分支模式及管径方面，CTA结果与手术结果之间未发现统计学显著差异（<0.001）。
本方案在DIEP皮瓣重建术前对穿支的CTA影像评估中显示出高准确性，CT与手术结果之间具有高重复性。
