| Objective:To explore the clinical application value of using Non-Enhanced Magnetic Resonance Angiography(NE-MRA)mapping perforator vessels in anterolateral thigh flap.By studying the NE-MRA sequence,the NE-MRA and Contrast-Enhanced Magnetic Resonance Angiography(CE-MRA)were used for mapping perforator vessels in anterolateral thigh flap,and the actual perforator information was verified during the operation to evaluate The accuracy of NE-MRA in mapping perforator vessels in anterolateral thigh flap,provides a safe and reliable method of mapping perforator vessels in anterolateral thigh flapMethods:First,with the joint efforts of MRA engineers and imaging physicians,we determined the TSE sequence parameters in the NE-MRA for mapping perforating vessels in the anterolateral thigh region.From January 2018 to April 2018,a total of 8 volunteers were recruited to perform the NE-MRA perforator positioning test,including 6 males and 2 females.Age 22 to 29 years old,average 27 years old.After establishing the coordinate system,the volunteers were used to locate the perforator vessels in the anterolateral thigh region through NE-MRA and CDS,and the NE-MRA perforator coincidence rate was recorded.The image quality was evaluated by Likert scale.secondly,we carried out the above NE-MRA on clinical patients.From May 2018 to October 2019,a total of 19 cases of Anterolateral Thigh Perforator Flap transplantation in our hospital were collected,there were 17 males and 2 females.Aged 20 to 64 years,with an average of 42.3 years.Injury mechanism:11 cases were crushed by heavy objects,4 cases were machine scoring injuries,2 cases were crush injuries,and 2 cases were falls.Defect sites:6 cases of soft tissue defects of 1 to 5 fingers,6 cases of soft tissue defects of palm,7 cases of soft tissue defects of feet.Exposed bone or muscle blood vessels and nerves were found on the wound surface.After establishing the coordinate system before surgery,the perforator vessels of the above patients were located by Siemens NE-MRA and CE-MRA.According to different examination methods,the perforator Vessel information was divided into two groups:NE-MRA group and the CE-MRA group,the perforator position,course,and the source information were recorded.The mapping information of the two groups were marked on the body surface before surgery,and verified when the flap was actually cut.For the distance between the preoperative map and the perforator branching out of the broad fascia,the difference between the distances of less than 10 mm was positive.The number of positives was counted in the two groups.?2 and consistency test was used to compare the two groups.The image quality,cost,and detection error of the two groups were evaluated,and the data comparison between each group was performed using paired T test.Results:Among the 8 volunteers,the NE-MRA coincidence rate was 97.2%.In NE-MRA,the Likert scale is 3.1±0.6,the angiography is clear,and the perforator coincidence rate is high.This sequence can be used in subsequent clinical studies.Among the patients,A total of 19 skin flaps were removed,with a flap area of about 12 cm × 7 cm?25 cm × 15 cm,about 16 flaps with a single page,and 3 flaps with bilobed flap.All skin flaps survived on schedule.Patients were followed up for 3?9 months,with an average of 5.16 months.Hand function scores:excellent in 2 cases,good in 7 cases,and moderate in 3 case.Ankle function evaluation:excellent in 3 cases,good in 3 cases,and fair in 1 case.In the 19 patients,42 were detected in the NE-MRA group before surgery,43 were perforated in the CE-MRA group,all the perforators in the NE-MRA group were detected by the CE-MRA,and 39 in the NE-MRA group were positive.In the CE-MRA group,40 perforating branches were positive.The sensitivity in the NE-MRA group was 86.7%(39/45),and the positive predictive value was 92.9%(39/42).The sensitivity in the CE-MRA group was 88.9%(40/45),and the positive predictive value was 93.0%(40/43).Between the two groups,The consistency test kappa=0.879,p<0.05,the difference was statistically significant,suggesting that NE-MRA and CE-MRA Exactly.During the operation,45 perforators,36 musculocutaneous perforators,and 9 septocutaneous perforators were found.NE-MRA group,33 musculocutaneous perforators and 9 septocutaneous perforators were found.CE-MRA group,34 musculocutaneous perforators and 9 septocutaneous perforators were found.Both groups were consistent with intraoperative results.In 19 cases of flaps,a total of 25 perforators were used:21 perforators come from descending branches,3 perforators come from transverse branches,1 perforator comes from oblique branches.NE-MRA and CE-MRA are exactly the same in predicting the source of perforation.In Likert scale,NE-MRA group(2.3±0.3)was lower than CE-MRA group(3.5±0.4),p=0.03<0.05,the difference was statistically significant.The NE-MRA group's examination cost of 400 yuan was less than the CE-MRA examination cost of 1300 yuan,p<0.05,difference was statistically significant.The detection error of the CE-MRA group(8.6±1.6 mm)was lower than that of the NE-MRA group(8.7±1.4 mm),P=0.211>0.05,and the difference was not statistically significant.Conclusion:NE-MRA can be used to locate the perforator of the anterior lateral femoral flap,and its positioning ability in terms of the source of perforation,running,and the location of the perforator passing through the broad fascia is basically the same as CE-MRA.NE-MRA has no ionizing radiation,image development is acceptable,soft tissue contrast is high,and no contrast agent is used.It is safe and reliable,and it is worth promoting technology that can be widely promoted in primary hospitals. |
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