Breast reconstruction with deep inferior epigastric artery perforator flap: 3.0-T gadolinium-enhanced MR imaging for preoperative localization of abdominal wall perforators

Purpose: To prospectively evaluate 3.0-T gadolinium-enhanced magnetic resonance (MR) imaging for localization of inferior epigastric artery (IEA) perforators before reconstructive breast surgery involving a deep inferior epigastric perforator (DIEP) flap. Materials and Methods: This study was exempt from institutional review board approval, and the requirement for informed patient consent was waived. Data were collected and stored in compliance with HIPAA regulations. Nineteen patients (mean age, 46.3 years) underwent three-dimensional gadolinium- enhanced 3.0-T MR imaging of the abdomen before undergoing DIEP flap breast reconstruction. Up to four of the largest perforators arising from the IEA on each side of the umbilicus were identified. The diameter, intramuscular course, and distance from the umbilicus of each perforator were recorded. One of the marked perforators on each side was labeled "the best" on the basis of an optimal combination of perforator features: diameter, intramuscular course, and location with respect to the flap edges. MR findings were compared with intraoperative findings. The two-tailed Student t test was used to compare the mean diameters of all perforators with the mean diameters of the perforators labeled as the best. Results: There were 30 surgical flaps, and 11 (58%) of the 19 patients underwent bilateral flap dissection. At surgery, 122 perforators were localized, and 118 (97%) of these perforators-with a mean diameter of 1.1 mm (range, 0.8-1.6 mm) - had been identified at preoperative MR imaging. Thirty perforators with a mean diameter of 1.4 mm (range, 1.0 -1.6 mm) were labeled as the best at MR imaging. Thirty-three perforators were harvested intraoperatively, and all of these had been localized preopera- tively. Twenty-eight (85%) of these 33 perforators were labeled as the best at MR imaging. Conclusion: Gadolinium-enhanced 3.0-T MR imaging can be used to accurately localize IEA perforators and to select the optimal perforator to be harvested for DIEP flap reconstructive breast surgery.