Related Experiment Video
Updated: Jul 9, 2026
An Experimental Human DIEP Flap Model to Investigate Preservation Strategies for Vascularized Composite Allografts and Free Flaps
Published on: December 5, 2025
Noncontrast Magnetic Resonance Angiography vs Contrast-Enhanced Computed Tomography in Deep Inferior Epigastric
Background:
Contrast-enhanced computed tomography angiography (CTA) is considered the "gold standard" in deep inferior epigastric perforator (DIEP) planning, despite its use of iodine-based contrast and ionizing radiation exposure. In contrast, magnetic resonance angiography (MRA) provides a radiation-free alternative, but conventional MRA requires the use of an expensive and potentially harmful gadolinium-based contrast agent. The development of contrast-free MRA protocols that preserve perforator mapping accuracy represents a promising area of investigation in DIEP flap planning.
Objectives:
The aim of this study was to evaluate whether an optimized noncontrast MRA protocol is noninferior to contrast-enhanced CTA in planning for delayed DIEP flap breast reconstruction (BR).
Methods:
This cohort study included 131 women (mean age 45.6 ± 7.1; BMI 28.5 ± 3.9 kg/m2), who underwent delayed unilateral DIEP flap BR. Group 1 (n = 81) underwent a noncontrast MRA with tailored preprocedural preparation, positioning, and scanning. Group 2 (n = 50) underwent standard contrast-enhanced CTA.
Results:
MRA significantly reduced operative time (333.0 ± 30.4 vs 348.9 ± 28.8 min; P = .003) and pedicle dissection time (35.7 ± 8.2 vs 40.1 ± 5.9 min; P < .001). The mean fascial incision length was shorter in the MRA group (9.1 ± 1.5 vs 10.6 ± 1.6 cm; P = .025). Diagnostic accuracy was 98.8% vs 99.6% (P = .4145); sensitivity was 98.3% vs 100.0%, and positive predictive value was 97.5% vs 98.7%, for MRA and CTA, respectively. The mean localization difference (ΔL) was 7.38 ± 2.59 vs 6.96 ± 2.34 mm (P = .238). Perfusion-related complication rates did not differ significantly between groups (P > .05). No significant differences were observed in baseline perforator characteristics.
Conclusions:
Optimized noncontrast MRA is a clinically reliable, noninferior alternative to CTA in DIEP flap planning, with additional advantages of reduced operative and dissection times.
Level Of Evidence: 3 (Therapeutic):
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