Article Figures & Data
Figures
- FIG 1.
A 49-year-old male with tonsillar squamous cell carcinoma was treated with glossectomy, mandibulotomy, and neck dissection. An anterolateral thigh free flap was utilized for treatment of the soft tissue defect. No wound failure was observed. DCE-MR imaging and CT perfusion were performed 3 days after the surgery. A, An ROI is placed within the junctional area of the free flap on contrast enhanced CT. B, Blood volume (mL/100 ml) and C, blood flow (mL/100 ml/min) are calculated and are 7.67 mL/100 ml, 29.7 mL/100 ml/min, respectively. D, An ROI is placed on the permeability map within the junctional area of the free flap and DCE-MR imaging parameters are calculated. E, Vp and F, Ktrans (minute-1) are 0.17 and 0.19 (minute-1), respectively. Red and white circled areas represent region of interests.
- FIG 2.
A 52-year-old woman with oral cavity squamous cell carcinoma was treated with mandibulectomy, glossectomy, tracheostomy, and neck dissection. A scapula free flap with latissimus dorsi was used to cover the soft tissue defect. The complication of venous congestion and ecchymosis was observed 2 days after the surgery. A, An ROI is placed within the junctional area of the free flap on contrast enhanced CT. B, Blood volume (mL/100 ml) and C, blood flow (mL/100 ml/min) are calculated and are 4.17 mL/100 ml and 11.3 mL/100 ml/min, respectively. D, An ROI is placed on the permeability map within the junctional area of the free flap and DCE-MR imaging parameters are calculated. E, Vp and F, Ktrans (minute-1) are 0.03 and 0.15 (minute-1), respectively. Red and white circled areas represent region of interests.
- FIG 3.
Receiver operating characteristic curves of CT perfusion parameters that showed statistically significant differences between groups I and II. AUC indicates area under the curve.
- FIG 4.
Receiver operating characteristic curves of DCE-MR imaging parameters that showed statistically significant differences between groups I and II. AUC indicates area under the curve.
Tables
Group I Group II P Value No. of patients 19 5 NA Sex (male/female) 14:5 2:3 .29 Age (yr) 63.9 (SD, 9.5) 58.0 (SD, 5.7) .20 BMI (kg/m2) 24.1 (22.4–29.3) 21.1 (16.1–24.7) .14 History of smoking 17/19 5/5 1 History of HT 4/19 2/5 .57 History of DM 1/19 2/5 .10 History of previous radiation 19/19 5/5 1 History of previous chemotherapy 13/19 4/5 1 Ischemia time (mins) 60 (45–95) 105 (90–109) .34 Presence of wound infection 1/19 3/5 .10 Presence of fluid collection 7/19 1/5 .38 Presence of pedicle vascular 7/19 4/5 .14 structure (Venous thrombosis: 1/5) Note:—NA indicates not applicable; BMI, body mass index; HT, hypertension; DM, diabetes mellitus.
↵a Groups I and II represent the group with successful free flap reconstruction and the group with wound failure, respectively. Values were described as mean (SD) or median (IQR).
- Table 2:
Diagnostic performance of CT perfusion and DCE-MR imaging in the prediction of wound failure after head and neck free flap reconstruction
Blood Flow (mL/100 mL/min) Blood Volume (mL/100 mL) MTT (Sec) tMIP Vp Ktrans (min−1) Peak Enhancement TME (Sec) Cutoff 17.3 5.62 16.1 10.7 0.06 0.15 155 113 Sensitivity 1 1 1 1 1 0.80 1 1 Specificity 0.94 0.88 0.88 0.94 0.81 0.94 0.81 0.69 PPV 0.75 0.60 0.60 0.75 0.63 0.80 0.63 0.50 NPV 1 1 1 1 1 0.94 1 1 Accuracy 0.95 0.90 0.90 0.95 0.86 0.91 0.86 0.76 AUC 0.96 0.96 0.96 0.98 0.92 0.82 0.91 0.81 Note:—PPV indicates positive predictive value; NPV, negative predictive value; AUC, area under the curve.
