PT  - JOURNAL ARTICLE
AU  - Y. Ota
AU  - A.G. Moore
AU  - M.E. Spector
AU  - K. Casper
AU  - C. Stucken
AU  - K. Malloy
AU  - R. Lobo
AU  - A. Baba
AU  - A. Srinivasan
TI  - Prediction of Wound Failure in Patients with Head and Neck Cancer Treated with Free Flap Reconstruction: Utility of CT Perfusion and MR Perfusion in the Early Postoperative Period
AID  - 10.3174/ajnr.A7458
DP  - 2022 Apr 01
TA  - American Journal of Neuroradiology
PG  - 585--591
VI  - 43
IP  - 4
4099  - http://www.ajnr.org/content/43/4/585.short
4100  - http://www.ajnr.org/content/43/4/585.full
SO  - Am. J. Neuroradiol.2022 Apr 01; 43
AB  - BACKGROUND AND PURPOSE: Free flap reconstruction in patients with head and neck cancer carries a risk of postoperative complications, and radiologic predictive factors have been limited. The aim of this study was to assess the factors that predict free flap reconstruction failure using CT and MR perfusion.MATERIALS AND METHODS: This single-center prospective study included 24 patients (mean age, 62.7 [SD, 9.0] years; 16 men) who had free flap reconstruction from January 2016 to May 2018. CT perfusion and dynamic contrast-enhanced MR imaging with conventional CT and MR imaging were performed between 2 and 4 days after the free flap surgery, and the wound assessments within 14 days after the surgery were conducted by the surgical team. The parameters of CT perfusion and dynamic contrast-enhanced MR imaging with conventional imaging findings and patient demographics were compared between the patients with successful free flap reconstruction and those with wound failure as appropriate. P < .05 was considered significant.RESULTS: There were 19 patients with successful free flap reconstruction and no wound complications (mean age, 63.9 [SD, 9.5] years; 14 men), while 5 patients had wound failure (mean age, 58.0 [SD, 5.7] years; 2 men). Blood flow, blood volume, MTT, and time maximum intensity projection (P = .007, .007, .015, and .004, respectively) in CT perfusion, and fractional plasma volume, volume transfer constant, peak enhancement, and time to maximum enhancement (P = .006, .039, .004, and .04, respectively) in dynamic contrast-enhanced MR imaging were significantly different between the 2 groups.CONCLUSIONS: CT perfusion and dynamic contrast-enhanced MR imaging are both promising imaging techniques to predict wound complications after head and neck free flap reconstruction.AIFarterial input functionDCEdynamic contrast-enhancedEESextravascular extracellular spaceIQRinterquartile rangeKeprate transfer constant between EES and blood plasma per minuteKtransvolume transfer constant between EES and blood plasma per minuteSCCsquamous cell carcinomaTMEtime to maximum enhancementtMIPtime maximum intensity projectionVeEES volume per unit tissue volumeVpfractional plasma volume