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CTA DIEP Flap Pre-operative

Last Updated: 2026-01-01 Author:

  • 1. Clinical Summary

    Series Phase Coverage
    CTA Arterial Arterial (bolus tracked) Mid-Liver to Greater Trochanters
    • Pre-operative planning for DIEP flap breast reconstruction

  • 2. Patient Prep

    • Position: Supine with arms at sides or on chest
    • NPO Status: NPO 2-4 hours

  • 3. IV Contrast & Injection

    Parameter Value
    Agent Isovue 370
    Volume 1.5 mL/kg
    Flow Rate 4-5 mL/s
    Duration 20s
    Timing Method Bolus Tracking
    ROI Placement Abdominal aorta
    Trigger (HU) 150 HU

    Use full dose if GFR > 30

    If GFR < 30

    Max Contrast = \(2*\left[\frac{\text{Patient Weight}}{75 \text{ kg}} * \text{eGFR}\right]\)

  • 4. Special Notes

    • Scan from mid-liver to greater trochanters. Remove tight-fitting underwear. If patient can exercise, do leg lifts on table before injection.
    • Additional Recons: 3D VR color-coded perforator map. Measure distances from umbilicus
    • 18-20G IV

    Safety First

    • Renal Function: Verify eGFR > 30
    • Allergy: Check allergy history
    • Map perforator locations. Measure vessel caliber. Identify dominant perforators. Note relationship to umbilicus. Prefer perforators below umbilicus.
    • Arms positioned to not obscure anterior abdominal wall
Series Name Start Location End Location Delay Slice Thickness Notes
Scout/Topogram Xiphoid Pubic symphysis N/A N/A AP
CTA Arterial Xiphoid Pubic symphysis Bolus tracked 0.625 mm Focus on abdominal wall
Plane Acquisition FOV Thickness/Increment Kernel IR Strength Notes
Axial Arterial Abdomen 1 mm/1 mm Vascular 3 Thin slice for perforator mapping
Coronal Arterial Abdomen 1.5 mm/1.5 mm Vascular 3 MIP to show perforator course
Sagittal Arterial Abdomen 2 mm/2 mm Vascular 3 Lateral views of perforators
3D VR Arterial Anterior abd wall 1 mm source Vascular 3 3D reconstruction for surgical planning