Computed tomography angiography versus digital subtraction angiography in vascular mapping for planning of microsurgical reconstruction of the mandible

Abstract

The aim of this work was to compare the potential of computed tomography angiography (CTA) with that of digital subtraction angiography (DSA) in vascular mapping of the external carotid artery (ECA) branches for planning of microvascular reconstructions of the mandible with osteomyocutaneous flaps. In 15 patients CTA and DSA were performed prior to surgery. Selective common carotid angiograms were acquired in two projection for both sides of the neck. Sixteen-slice spiral computed tomography was performed with a dual-phase protocol, using the arterial phase images for 3D CTA reconstruction. Thin-slab maximum intensity projections and volume rendering were employed for postprocessing of CTA data. The detectability of the different ECA branches in CTA and DSA was evaluated by two examiners. No statistically significant differences between CTA and DSA (p=0.097) were found for identifying branches relevant for microsurgery. DSA was superior to CTA if more peripheral ECA branches were included (P=0.030). CTA proved to be a promising alternative to DSA in vascular mapping for planning of microvascular reconstruction of the mandible.

Computed tomography and magnetic resonance angiography in the evaluation of aberrant origin of the external carotid artery branches

“…In the vast majority of the cases considered in our study, CTA has proved clearly superior to the MRA in the identiWcation of an aberrant origin of the branches of the ECA due to a higher spatial resolution (also allowing to follow the smallest vascular branches) [18] and the possibility to obtain tridimensional reformations of high anatomical detail and to show the relationship between the vessel along its entire course and the surrounding bony structures, useful anatomical landmark; its secondary considerable advantages are related to a shorter examination time and to the possibility to evaluate also claustrophobic patients, carriers of pacemakers, hearing aids, mechanical heart valves, metal implants and neurostimulators. For these reasons CTA is the method of choice in the planning of interventions on the head and neck and, more generally, in the evaluation of diseases in this anatomical district; compared with digital subtraction angiography (DSA), the gold-standard technique in the vascular imaging vascular, CTA is associated with a lower rate of vascular complications (particularly ischemic events), presenting a diagnostic accuracy comparable to it, with the possibility of viewing thin terminal branches.…”

“…For these reasons CTA is the method of choice in the planning of interventions on the head and neck and, more generally, in the evaluation of diseases in this anatomical district; compared with digital subtraction angiography (DSA), the gold-standard technique in the vascular imaging vascular, CTA is associated with a lower rate of vascular complications (particularly ischemic events), presenting a diagnostic accuracy comparable to it, with the possibility of viewing thin terminal branches. Tridimensional rendering, characterized by a high correspondence with the anatomical reality, is an invaluable reference for surgical and interventional procedures on the head and neck in order to reduce intraoperative complications such as ligatures or accidental injury of vessels; in the planning of a selective or superselective chemoembolization of a tumor of the head-neck, then, CTA can accurately display vascular structures related to the tumor by limiting the toxic complications in the healthy surrounding tissues [9,16,18,31,34]. Despite these considerations, however, MRA is an extremely viable alternative to CTA in patients with allergy to iodine-based contrast media or renal failure, maintaining also an undisputed role in the characterization of expansive lesions associated with the vascular anomalies [2,5].…”

Visualization of external carotid artery and its branches: Non–contrast‐enhanced MR angiography using balanced steady‐state free‐precession sequence and a time‐spatial labeling inversion pulse

“…Contrast-enhanced MRA has been applied to the ECA system and high-resolution images can be obtained especially on 3T MRI units (13), although it has some disadvantages such as potential nephrotoxicity and association with nephrogenic systemic fibrosis (14). Computed tomography angiography can also be used for the external carotid evaluation (15), but radiation exposure is inevitable and iodine-based contrast materials are potentially nephrotoxic (16) and have a relatively high risk of allergic adverse reactions (17).…”

Value of automatic bone subtraction in cranial CT angiography: comparison of bone-subtracted vs. standard CT angiography in 100 patients

“…The temporal and spatial resolution of these protocols has greatly improved with the introduction of multi-detector-row CT (MDCT). Thus, supraaortic MDCT angiography is increasingly considered a noninvasive alternative to digital subtraction angiography (DSA) in pretreatment planning [9][10][11][12][13][14][15][16]. However, comparing DSA to MDCT angiography, delineation of vasculature closely adjacent to bony structures is sometimes limited.…”