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Utility of Breast MRI in Preoperative Planning for Free Flap Breast Reconstruction
Can Ozturk, MD1, Ronald A. Charles, MD1, Nidhi Sharma, MD2, Melinda Sava, MD2, Melanie Chellman-Jeffers, MD2, Cemile N Ozturk, MD1, and Graham S. Schwarz, MD1, (1)Plastic and Reconstructive Surgery, C
Cleveland Clinic Foundation
2013-03-14
Presenter: Can Ozturk
Affidavit:
Approximately 30 %
Director Name: Risal Djohan
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Introduction
Noninvasive angiographic imaging modalities have been increasingly used to aid in flap design and perforator vessel mapping in free flap breast reconstruction.
The aim of this study is to evaluate how intraoperative internal mammary (IMA/IMV) vessel measurements correlate with breast MRI measured vessel caliber.
Materials & Methods
Following IRB approval, prospectively measured IMA and IMV diameters were obtained in consecutive patients.
Using standard workstation measurement tool software a senior breast radiologist independently noted vessel diameters at corresponding intraoperatively-recorded anatomic reference points.
Correlation models evaluating intraoperative and MRI measurements were developed and analyzed for significance using methods of repeated measures mixed models.
Results
Thirty one vessels were evaluated (13 arteries, 18 veins) in 8 consecutive women undergoing free flap breast reconstruction (5 bilateral, 3 unilateral). Intraoperative mean IMA diameter was 2.8 mm (range 2 - 4 mm), mean IMV1 diameter was 3 mm (range 2 - 4.5 mm) and mean IMV2 diameter was 2.1 mm (range 1.5 - 3 mm). Respective MRI mean diameters were: IMA 3 mm (range 2.1 - 4 mm), IMV1 2.8 mm (range 2.2 – 4.8 mm) and IMV2 2.3 mm (range 1.6 – 2.9 mm).
Significant correlation existed between intraoperative and MRI measurements for both arteries and veins (arteries r= 0.77, p=0.0056 and veins r=0.7, p=0.0045).
Conclusion
Breast MRI measurements correlate well with actual IMA and IMV diameters, thereby, allowing vessel size prediction as well as anatomic localization. In centers using this modality, standard Breast MRI may be a useful adjunct in free flap planning.
