Dissection of the selected perforator should preserve muscle innervation and avoid fat necrosis [1,3,4]. A short intramuscular course allows for successful dissection [3,14,15]. Perforators are reported by the location where they pierce the anterior rectus sheath in relation to the umbilicus. This is important because, although the perforator can move within the subcutaneous tissues with applied pressure, its position at the rectus sheath is fixed relative to the umbilicus [5]. All elements are essential: 1) timing, 2) reconstructions/reformats, and 3) 3-D renderings. Standard CTs with contrast also include timing issues and reconstructions/reformats. Only in CTA, however, is 3-D rendering a required element. This corresponds to the definitions that the CMS has applied to the Current Procedural Terminology codes. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through representation of such organizations on expert panels. Participation on the expert panel does not necessarily imply endorsement of the final document by individual contributors or their respective organization. Reprint requests to: publications@acr.org OR Discussion of Procedures by Variant Variant 1: Imaging of deep inferior epigastric arteries for surgical planning (breast reconstruction surgery). Initial imaging. The goal of preoperative imaging is to aid the surgical team in preoperative planning given the variability of the DIEA perforator branches anatomy between patients, and even between the left and right hemiabdomen of the same patient.
Imaging of Deep Inferior Epigastric Arteries for Surgical Planning Breast Reconstruction Surgery . Dissection of the selected perforator should preserve muscle innervation and avoid fat necrosis [1,3,4]. A short intramuscular course allows for successful dissection [3,14,15]. Perforators are reported by the location where they pierce the anterior rectus sheath in relation to the umbilicus. This is important because, although the perforator can move within the subcutaneous tissues with applied pressure, its position at the rectus sheath is fixed relative to the umbilicus [5]. All elements are essential: 1) timing, 2) reconstructions/reformats, and 3) 3-D renderings. Standard CTs with contrast also include timing issues and reconstructions/reformats. Only in CTA, however, is 3-D rendering a required element. This corresponds to the definitions that the CMS has applied to the Current Procedural Terminology codes. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through representation of such organizations on expert panels. Participation on the expert panel does not necessarily imply endorsement of the final document by individual contributors or their respective organization. Reprint requests to: publications@acr.org OR Discussion of Procedures by Variant Variant 1: Imaging of deep inferior epigastric arteries for surgical planning (breast reconstruction surgery). Initial imaging. The goal of preoperative imaging is to aid the surgical team in preoperative planning given the variability of the DIEA perforator branches anatomy between patients, and even between the left and right hemiabdomen of the same patient.