The Accuracy of Computed Tomographic Angiography for Mapping the Perforators of the DIEA: A Cadaveric Study

BACKGROUND: The deep inferior epigastric artery (DIEA) perforator flap is increasingly used for breast reconstruction, with preoperative imaging sought as a means of improving operative outcome. Computed tomographic angiography has been recently described as the preferred imaging modality; however, formal evaluation of computed tomographic angiography has not been described. A cadaveric study was undertaken to evaluate the accuracy of computed tomographic angiography for perforator mapping. METHODS: Ten cadaveric hemiabdominal walls from five fresh cadavers underwent contrast injection of each DIEA and subsequent computed tomographic scanning, with each DIEA and all perforating branches documented. Dissection was then performed, with the recording of the course of the DIEA and the course of all perforators in each specimen. The concordance of computed tomographic angiography with dissection findings was evaluated. RESULTS: Cadaveric computed tomographic angiography identified 154 perforators in 10 hemiabdominal walls. Computed tomographic angiography was highly accurate, with eight false-positives and six false-negatives on cadaveric computed tomographic angiography, establishing an overall sensitivity of 96 percent and a positive predictive value of 95 percent for mapping perforators. For perforators greater than 1 mm in diameter, the sensitivity was 100 percent and the positive predictive value was 100 percent. CONCLUSIONS: Computed tomographic angiography is a highly accurate tool for identifying the perforators of the DIEA before DIEA perforator flaps for breast reconstruction. Preoperative identification of these vessels can aid planning for the preferred hemiabdomen for dissection, and may save operative time, angst, and potentially complications.