Time-of-Flight Angiography in Ultra-High-Field 7 T MRI for the Evaluation of Peroneal Perforator Arteries Before Osseomyocutaneous Flap Surgery.
Journal
Investigative radiology
ISSN: 1536-0210
Titre abrégé: Invest Radiol
Pays: United States
ID NLM: 0045377
Informations de publication
Date de publication:
01 03 2023
01 03 2023
Historique:
pubmed:
28
9
2022
medline:
15
2
2023
entrez:
27
9
2022
Statut:
ppublish
Résumé
Presurgical identification and morphologic characterization of the peroneal perforator arteries (PPAs) are essential for osseomyocutaneous flap surgery. The aim of this study was to evaluate PPAs using time-of-flight (TOF) angiography in 7 T magnetic resonance imaging in comparison with dual-energy computed tomographic angiography (CTA). In this prospective study, TOF angiography and CTA of both lower legs were acquired before flap surgery from 07/2019 to 02/2020. Magnetic resonance imaging was performed using a dedicated 28-channel knee coil with an acquisition time of 9:55 minutes (voxel size: 0.4 × 0.4 × 0.8 mm). Computed tomographic angiography was acquired with a third-generation dual-source computed tomography on the same day. Virtual monoenergetic reconstructions at 40 keV photon energy served as the standard of reference for PPA identification and subtyping. Two independent readers assessed the image quality, quantity, length assessment, and classification according to surgical considerations of PPAs for TOF angiography and CTA. Both TOF angiography and CTA were used for presurgical flap design and were evaluated by an orofacial surgeon. Ten patients (mean age, 59.9 ± 14.9 years; 7 men) were included. Time-of-flight angiography and CTA identified 53 and 51 PPAs in total, respectively. Time-of-flight angiography showed superior image quality (both readers, P < 0.05). Time-of-flight angiography enabled specific classification of PPA subtypes more often (53 vs 39; P < 0.05), and both readers reported higher diagnostic confidence for TOF angiography than CTA in all patients (interrater agreement κ = 0.8; P < 0.05). Regarding length assessment, PPAs were significantly more conspicuous with TOF angiography (TOF mean , 50 ± 11 mm; CTA mean , 40 ± 9 mm; P = 0.001). In comparison with CTA, TOF angiography prospectively changed the orofacial surgeon's final decision on the presurgical selected PPAs in 60% of cases. Presurgical assessment of PPAs is feasible using TOF in 7 T magnetic resonance imaging. Moreover, TOF angiography was superior to CTA for classifying and identifying PPAs, which may facilitate the planning of reconstructive surgery.
Identifiants
pubmed: 36165876
doi: 10.1097/RLI.0000000000000926
pii: 00004424-202303000-00005
pmc: PMC9914154
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
216-222Informations de copyright
Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.
Déclaration de conflit d'intérêts
Conflicts of interest and sources of funding: none declared.
Références
Hidalgo DA. Fibula free flap: a new method of mandible reconstruction. Plast Reconstr Surg . 1989;84:71–79.
Kumar BP, Venkatesh V, Kumar KA, et al. Mandibular reconstruction: overview. J Maxillofac Oral Surg . 2016;15:425–441.
Iorio ML, Cheerharan M, Olding M. A systematic review and pooled analysis of peroneal artery perforators for fibula osteocutaneous and perforator flaps. Plast Reconstr Surg . 2012;130:600–607.
Yu P, Chang EI, Hanasono MM. Design of a reliable skin paddle for the fibula osteocutaneous flap: perforator anatomy revisited. Plast Reconstr Surg . 2011;128:440–446.
Brown JS, Lowe D, Kanatas A, et al. Mandibular reconstruction with vascularised bone flaps: a systematic review over 25 years. Br J Oral Maxillofac Surg . 2017;55:113–126.
Fukaya E, Saloner D, Leon P, et al. Magnetic resonance angiography to evaluate septocutaneous perforators in free fibula flap transfer. J Plast Reconstr Aesthet Surg . 2010;63:1099–1104.
Beppu M, Hanel DP, Johnston GH, et al. The osteocutaneous fibula flap: an anatomic study. J Reconstr Microsurg . 1992;8:215–223.
Gilbert A. Free vascularized bone grafts. Int Surg . 1981;66:27–31.
Chow LC, Napoli A, Klein MB, et al. Vascular mapping of the leg with multi-detector row CT angiography prior to free-flap transplantation. Radiology . 2005;237:353–360.
Ono S, Hayashi H, Ohi H, et al. Imaging studies for preoperative planning of perforator flaps: an overview. Clin Plast Surg . 2017;44:21–30.
Sandhu GS, Rezaee RP, Wright K, et al. Time-resolved and bolus-chase MR angiography of the leg: branching pattern analysis and identification of septocutaneous perforators. AJR Am J Roentgenol . 2010;195:858–864.
Rutland JW, Delman BN, Gill CM, et al. Emerging use of ultra-high-field 7 T MRI in the study of intracranial vascularity: state of the field and future directions. AJNR Am J Neuroradiol . 2020;41:2–9.
Edelman RR, Koktzoglou I. Noncontrast MR angiography: an update. J Magn Reson Imaging . 2019;49:355–373.
Behzadi AH, Zhao Y, Farooq Z, et al. Immediate allergic reactions to gadolinium-based contrast agents: a systematic review and meta-analysis. Radiology . 2018;286:471–482.
Fukaya E, Grossman RF, Saloner D, et al. Magnetic resonance angiography for free fibula flap transfer. J Reconstr Microsurg . 2007;23:205–211.
Landis JR, Koch GG. An application of hierarchical kappa-type statistics in the assessment of majority agreement among multiple observers. Biometrics . 1977;33:363–374.
Al Deek NF, Kao HK, Wei FC. The fibula osteoseptocutaneous flap: concise review, goal-oriented surgical technique, and tips and tricks. Plast Reconstr Surg . 2018;142:913e–923e.
Young DM, Trabulsy PP, Anthony JP. The need for preoperative leg angiography in fibula free flaps. J Reconstr Microsurg . 1994;10:283–287; discussion 7–9.
Albrecht MH, Vogl TJ, Martin SS, et al. Review of clinical applications for virtual monoenergetic dual-energy CT. Radiology . 2019;293:260–271.
Cha MJ, Kang DY, Lee W, et al. Hypersensitivity reactions to iodinated contrast media: a multicenter study of 196 081 patients. Radiology . 2019;293:117–124.
Miyazaki M, Lee VS. Nonenhanced MR angiography. Radiology . 2008;248:20–43.
Grochowski C, Staśkiewicz G. Ultra high field TOF-MRA: a method to visualize small cerebral vessels. 7 T TOF-MRA sequence parameters on different MRI scanners—literature review. Neurol Neurochir Pol . 2017;51:411–418.
Raval SB, Britton CA, Zhao T, et al. Ultra-high field upper extremity peripheral nerve and non-contrast enhanced vascular imaging. PLoS One . 2017;12:e0175629.
Schusterman MA, Reece GP, Miller MJ, et al. The osteocutaneous free fibula flap: is the skin paddle reliable? Plast Reconstr Surg . 1992;90:787–793; discussion 94–98.
Jones NF, Monstrey S, Gambier BA. Reliability of the fibular osteocutaneous flap for mandibular reconstruction: anatomical and surgical confirmation. Plast Reconstr Surg . 1996;97:707–716; discussion 17–18.
Ha Y, Yeo KK, Piao Y, et al. Peroneal flap: clinical application and cadaveric study. Arch Plast Surg . 2017;44:136–143.
Toto JM, Chang EI, Agag R, et al. Improved operative efficiency of free fibula flap mandible reconstruction with patient-specific, computer-guided preoperative planning. Head Neck . 2015;37:1660–1664.
Seruya M, Fisher M, Rodriguez ED. Computer-assisted versus conventional free fibula flap technique for craniofacial reconstruction: an outcomes comparison. Plast Reconstr Surg . 2013;132:1219–1228.
Fujita S, Hagiwara A, Otsuka Y, et al. Deep learning approach for generating MRA images from 3D quantitative synthetic MRI without additional scans. Invest Radiol . 2020;55:249–256.
Rietsch SHG, Orzada S, Maderwald S, et al. 7 T ultra-high field body MR imaging with an 8-channel transmit/32-channel receive radiofrequency coil array. Med Phys . 2018;45:2978–2990.
Julious SA. Sample size of 12 per group rule of thumb for a pilot study. Pharm Stat . 2005;4:287–291.
Yang X, Miller MJ, Friel HT, et al. Perforator phase contrast angiography of deep inferior epigastric perforators: a better preoperative imaging tool for flap surgery than computed tomographic angiography? Invest Radiol . 2017;52:334–342.