Cine Computed Tomography Angiography Evaluation of Blood Flow for Full Face Transplant Surgical Planning

Objective: Screening for full face transplantation candidates includes computed tomographic vascular mapping of the external carotid distribution for potential arterial and venous anastomoses. The purpose of this study is to illustrate the benefits and drawbacks of cine computed tomographic imaging for preoperative vascular mapping compared with best arterial and venous phase static images. Methods: Two image data sets were retrospectively created and compared for diagnostic findings. The first set of images was the clinical cine computed tomographic acquisition including all phases. The second set of images was composed of the best arterial and best venous phases extracted from the cine loop and determined by the quality of contrast enhancement. For each patient, the benefits and drawbacks of the cine loop were documented in consensus by a plastic surgeon and a radiologist. Results: Cine loop analysis identified retrograde arterial filling not illustrated on the static images alone. Cine assessment identified most of the major vessels necessary for surgery, whereas the static images depicted small vessels more clearly, particularly in the crowded vessel takeoffs. Conclusions: Cine computed tomographic images provide data on direction of blood flow, which is important for preoperative planning. Combination of cine computed tomographic and the best static images will allow comprehensive vascular assessment necessary for future successful full face transplantation.