Whole-body magnetic resonance angiography for presurgical planning of free-flap head and neck reconstruction

Abstract

Objectives: Aim of the study was to evaluate if a whole-body magnetic resonance angiography (MRA) protocol meets the requirements to evaluate the donor and host site target vessels for planning of microvascular head and neck reconstructions.

Patients and methods: In 20 patients, scheduled for reconstruction of the mandible with fibular free flaps, contrast-enhanced whole-body MRA was performed prior to surgery. 32-Channel 1.5-T MR angiograms were acquired using a 2-step contrast (gadobutrol) injection scheme to visualize the arterial vasculature from head to feet. Maximum intensity projection and multiplanar reconstruction technique was employed to visualize MRA data. For image evaluation the arterial tree was divided into 51 segments. The presence of artefacts impairing diagnostic quality was noted. Evaluable segments were assessed regarding the presence of stenoses >50% diameter reduction, occlusions or aneurysms.

Results: No adverse reactions or complications occurred. Of 1020 vessel segments 1003 (98.3%) were evaluable. 36 stenoses >50%, 50 occlusions and one aneurysm were observed. In 21 of 40 lower limbs relevant atherosclerotic changes were depicted.

Conclusion: Whole-body MRA proved to be a suitable three-dimensional, noninvasive, nonionising modality for preoperative evaluation of the entire arterial vasculature.