基于笛卡尔排序的对比增强磁共振血管成像在股前外侧皮瓣术前评估中的差异亚采样。
Differential Subsampling with Cartesian Ordering Contrast-Enhanced Magnetic Resonance Angiography for the Preoperative Assessment of Anterolateral Thigh Flap.
机构信息
Department of Radiology, The Second Hospital of Shandong University, Cheeloo Colleage of Medicine, Jinan, China.
Department of Hand and Foot Surgery, The Second Hospital of Shandong University, Cheeloo Colleage of Medicine, Jinan, China.
出版信息
Korean J Radiol. 2022 Aug;23(8):803-810. doi: 10.3348/kjr.2021.0696. Epub 2022 Jun 20.
OBJECTIVE
To investigate the clinical application of differential subsampling with Cartesian ordering (DISCO) contrast-enhanced (CE) magnetic resonance angiography for anterolateral thigh (ALT) flap transplantation, using operative findings as a reference.
MATERIALS AND METHODS
Thirty patients (21 males and nine females; mean age ± standard deviation, 45.5 ± 15.6 years) who were scheduled to undergo reconstruction with ALT flaps between June 2020 and June 2021 were included in the prospective study. Before ALT flap transplantation, patients were scanned using CE-DISCO imaging. All acquired DISCO images of the 60 lower limbs (both sides from each patient) were analyzed using maximum intensity projection and volume rendering methods. Two experienced radiologists were employed to examine the patterns of the lateral circumflex femoral artery (LCFA), its branches, and perforators and their skin termini, which were compared with the operative findings.
RESULTS
Using CE-DISCO, the patterns of the LCFA and its branches were clearly identified in all patients. Four different origins of the LCFA were found among the 60 blood vessels: type I (44/60, 73.3%), type II (6/60, 10.0%), type III (8/60, 13.3%), and type IV (2/60, 3.3%). Owing to a lack of perforators entering the skin, two patients did not undergo ALT flap transplantation. For the remaining 28 patients, the ALT flaps in 26 patients were successfully operated without flap re-selection during the operation, while the remaining two patients underwent other surgical procedures due to the thin diameter of the perforator or injury of the perforator during the operation. The success rate of flap transplantation was 92.8% (26/28). All transplanted flaps exhibited good blood supply and achieved primary healing without infection or delayed healing.
CONCLUSION
CE-DISCO imaging can be an effective method for preoperative perforator imaging before ALT flap transplantation.
目的
以手术所见为参照，探讨笛卡尔有序差分采样（DISCO）对比增强磁共振血管成像（CE-MRA）在股前外侧（ALT）皮瓣移植中的临床应用。
材料与方法
本前瞻性研究纳入 2020 年 6 月至 2021 年 6 月期间拟行 ALT 皮瓣重建的 30 例患者（21 名男性，9 名女性；平均年龄±标准差，45.5±15.6 岁）。在 ALT 皮瓣移植前，患者接受 CE-DISCO 成像扫描。使用最大密度投影和容积再现方法对 60 条下肢（每位患者的两侧）的所有采集 DISCO 图像进行分析。两名有经验的放射科医生检查旋股外侧动脉（LCFA）及其分支和穿支的分布模式及其皮支终末，并与手术所见进行比较。
结果
使用 CE-DISCO，60 条血管均能清晰显示 LCFA 及其分支的走行。60 条血管中发现 LCFA 有 4 种不同起源：Ⅰ型（44/60，73.3%）、Ⅱ型（6/60，10.0%）、Ⅲ型（8/60，13.3%）和Ⅳ型（2/60，3.3%）。由于缺乏进入皮肤的穿支，2 例患者未行 ALT 皮瓣移植。对于其余 28 例患者，26 例患者的 ALT 皮瓣在手术中无需皮瓣再次选择即可顺利进行，而其余 2 例患者由于穿支直径较细或术中穿支损伤，改行其他手术。皮瓣移植成功率为 92.8%（26/28）。所有移植皮瓣血供良好，无感染或延迟愈合，均一期愈合。
结论
CE-DISCO 成像可作为 ALT 皮瓣移植前术前穿支成像的有效方法。
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