Equilibrium-Phase High Spatial Resolution Contrast-Enhanced MR Angiography at 1.5T in Preoperative Imaging for Perforator Flap Breast Reconstruction

OBJECTIVES: The aim was (i) to evaluate the accuracy of equilibrium-phase high spatial resolution (EP) contrast-enhanced magnetic resonance angiography (CE-MRA) at 1.5T using a blood pool contrast agent for the preoperative evaluation of deep inferior epigastric artery perforator branches (DIEP), and (ii) to compare image quality with conventional first-pass CE-MRA. METHODS: Twenty-three consecutive patients were included. All patients underwent preoperative CE-MRA to determine quality and location of DIEP. First-pass imaging after a single bolus injection of 10 mL gadofosveset trisodium was followed by EP imaging. MRA data were compared to intra-operative findings, which served as the reference standard. RESULTS: There was 100% agreement between EP CE-MRA and surgical findings in identifying the single best perforator branch. All EP acquisitions were of diagnostic quality, whereas in 10 patients the quality of the first-pass acquisition was qualified as non-diagnostic. Both signal- and contrast-to-noise ratios were significantly higher for EP imaging in comparison with first-pass acquisitions (p<0.01). CONCLUSIONS: EP CE-MRA of DIEP in the preoperative evaluation of patients undergoing a breast reconstruction procedure is highly accurate in identifying the single best perforator branch at 1.5Tesla (T). Besides accuracy, image quality of EP imaging proved superior to conventional first-pass CE-MRA.