Comparison of Cinematic Rendering and maximum intensity projection in abdominal-based autologous breast reconstruction
Theresa Hauck, MD, Andreas Arkudas, MD, Raymund E. Horch, MD, Armin Ströbel, Matthias S. May, MD, Johannes Binder, MD, Christian Krautz, MD, Ingo Ludolph, MD
Background Cinematic Rendering (CR) is a recently introduced post-processing 3D-visualization imaging tool. The aim of this study was to assess its clinical value in the preoperative planning of deep inferior epigastric artery perforator (DIEP) or muscle-sparing transverse rectus abdominis myocutaneous (MS-TRAM) flaps, and to compare it to maximum intensity projection (MIP) images. The study presents the first application of CR for perforator mapping prior to autologous breast reconstruction.
Methods Two senior surgeons independently analyzed CR and MIP images based on computed tomography angiography (CTA) datasets of 20 patients in terms of vascular pedicle characteristics, the possibility to harvest a DIEP or MS-TRAM flap, and the side of the flap harvest. We calculated inter- and intra-observer agreement in order to examine the accordance of both image techniques.
Results We observed a good inter- and intra-observer agreement concerning the type of flap and the side of the flap harvest. However, the agreement on the pedicle characteristics varies depending on the considered variable. Both investigators identified a significantly higher number of perforators with MIP compared to CR (observer one p<0.0001, observer two p<0.0385).
Conclusion The current study serves as an explorative study, showing first experiences with CR in abdominal-based autologous breast reconstruction. In addition to MIP images, CR might improve the surgeon's understanding of the individual's anatomy. Future studies are required to compare CR with other 3D visualization tools and its possible effects on operative parameters.
Read Full Article Here: https://doi.org/10.1016/j.bjps.2021.09.011