MR Imaging of the Muscular Component of Myocutaneous Flaps in the Head and Neck
June Chonga,
Ling Ling Chana,
Howard N. Langsteina and
Lawrence E. Ginsberg
,a
a From the Departments of Radiology (J. C., L. L. C., L. E. G.) and Plastic and Reconstructive Surgery (H. N. L.), The University of Texas M. D. Anderson Cancer Center, Houston, TX.
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FIG 1. 50-year-old man with adenoid cystic carcinoma of the maxillary sinus. MR images were obtained 2 months after right orbital exenteration, radical maxillectomy, and rectus abdominis free flap reconstruction.
A, Coronal noncontrast T1-weighted (400/9/2) image shows typical striations within the large muscular flap (arrows) occupying the orbitomaxillary defect.
B, Contrast-enhanced, fat-suppressed T1-weighted (583/9/2) image shows bright enhancement of the muscular flap component.
C, Axial fast spin-echo T2-weighted (4733/98/2) image with fat suppression shows signal hyperintensity of the muscular flap component (asterisks). Though less evident than on the T1-weighted sequence, muscular striations can be seen on this image.
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FIG 2. 39-year-old woman with neurofibrosarcoma of the nasopharynx and central skull base after resection and placement of a rectus abdominis free flap. This case illustrates persistent enhancement and absence of atrophy of a muscular graft over several years.
A, Contrast-enhanced, fat-suppressed T1-weighted (600/16/1.5) image obtained several months postoperatively shows bright enhancement of the graft in the nasopharyngeal region (arrows).
B–D were obtained 3 years after surgery.
B, Axial noncontrast T1-weighted (500/9/2) image shows a soft-tissue structure representing a nearly purely myogenous graft in the central skull base (arrows). Striations are only faintly seen centrally.
C, Contrast-enhanced, fat-suppressed T1-weighted (583/9/2) image shows bright enhancement of the graft. Internal heterogeneity is caused largely by striations. Because of the enhancement, this graft was repeatedly misinterpreted as persistent tumor over the course of several years by numerous radiologists. No tumor recurrence has ever been documented in this operative site. Note the similarity with A, obtained 3 years earlier.
D, Axial fast spin-echo T2-weighted (4733/98/2) image with fat suppression shows only moderate signal hyperintensity of the graft. Striations are apparent on this sequence.
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FIG 3. 51-year-old woman after radical maxillectomy and orbitectomy for poorly differentiated squamous cell carcinoma of maxillary sinus origin and placement of a large rectus abdominis free flap. This case illustrates persistent enhancement and subsequent flap atrophy.
A and B were obtained 4 months after surgery.
A, Axial T1-weighted (400/9/2) image shows an anteriorly situated fatty component (black dots) and a posteriorly situated muscular component with internal striations (asterisks).
B, Contrast-enhanced, fat-suppressed T1-weighted (450/9/2) image shows signal suppression in the fatty component and bright enhancement of the muscular component (asterisks).
C, Contrast-enhanced, fat-suppressed T1-weighted (583/9/2) image obtained 9 months after A and B shows persistent enhancement of a much smaller, atrophied muscular graft component (arrowheads). The size of the fatty component is unchanged.
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FIG 4. 56-year-old man after resection of a high-grade sarcoma of the masticator space and placement of a pectoralis rotational flap. Imaging studies were obtained 2 months postoperatively. This case illustrates nonenhancement of the muscular graft component.
A, Axial T1-weighted (450/9/2) image shows a medially situated fatty graft component (black dots) and a laterally situated muscular graft component with obvious striations (arrowheads).
B, Contrast-enhanced, fat-suppressed T1-weighted (583/9/2) image shows signal suppression of the fatty component and no enhancement of the muscular graft component.
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