MR Angiography for Preoperative Evaluation of Vascularized Fibular Grafts

Two magnetic resonance (MR) angiography pulse sequences, two-dimensional (2D) time of flight (TOF) and multislah three-dimensional (3D) TOF, were compared for ease of application and capability of depicting the arterial trifurcation in candidates for vascularized fibular grafts. Both 2D TOF and multislab 3D TOF MR angiography procedures were performed to image the lower legs of 15 healthy volunteers and six patients. Three radiologists evaluated each study for the number of trifurcation vessels depicted at the knee and at the ankle, the corresponding degree of confidence, and the presence of anatomic variants. All trifurcation vessels were identified at the level of the knee with a high degree of confidence. Usually two vessels could be identified at the ankle with a slightly lower degree of confidence. A higher number of vessels were identified at the ankle with the 2D TOF technique than with the 3D TOF technique. A number of anatomic variants were identified. Anatomy of all six patients was identified correctly and confirmed at surgery. Both 2D TOF and multislab 3D TOF are useful techniques to define the arterial anatomy of the lower leg and have proved valuable in preoperative planning for vascularized grafts. Vessel visualization at the level of the ankle was superior with the 2D TOF technique.