Comparison of Iomeprol-400 with Ultravist-370 and Omnipaque-350 in pre-Operative CT-Angiography for the Visualisation of the Deep Inferior Epigastric Perforators (DIEPs)

Purpose: Autologous breast reconstructive surgery using deep inferior epigastric perforator (DIEP) flaps has become mainstream treatment for breast reconstructive surgery. CT-Angiography (CTA) with the use of 3D image reconstruction is routinely used to characterise the DIEP arteries in order to aid surgical planning.
The purpose of this study was to compare arterial enhancement of the DIEP using the new contrast agent iomeprol-400 versus the contrast agents ultravist-370 and omnipaque-350.

Methods: Retrospective study of patients who underwent CTA of the abdominal arteries during administration of iomeprol-400 versus ultravist-370 or omnipaque-350. Patients were matched for sex and age. An offside reader evaluated the scans in terms of technical adequacy, vessel visualization and arterial contrast enhancement in Hounsfield units (HUs).

Results: The 22 hemiabdominal walls of 11 female patients who were administered iomeprol-400 were compared to the 22 hemiabdominal walls of 11 patients who were administered ultravist-370 or omnipaque-350.

A significantly higher arterial contrast enhancement was observed with iomeprol-400 at the proximal DIEP just distal to its origin, and distally at its intramuscular perforator branches superficial to the rectus abdominis muscle.

Conclusion: This study demonstrated the significant benefit of iomeprol-400 administration in abdominal CTA for arterial enhancement of the DIEP arteries compared to the administration of ultravist-370 or omnipaque-350.