Comparison of Iomeprol-400, Ultravist-370, and Omnipaque-350 in Preoperative Computed Tomography for Visualizing the Deep Inferior Epigastric Perforators.

[BACKGROUND] Breast reconstruction using the deep inferior epigastric perforator (DIEP) flap is considered the gold standard, due to its natural results and minimal damage to the donor site. Precise preoperative imaging to identify optimal perforators is essential for successful DIEP flap surgery, improving surgical outcomes and patient satisfaction. This study evaluates the efficacy of Iomeprol-400, a high iodine concentration contrast agent, against Ultravist-370 and Omnipaque-350 in enhancing visualization of DIEPs on preoperative computed tomography angiography (CTA).

[METHODS] We performed a retrospective comparative study of 40 female patients who underwent preoperative CTA with contrast injection of Iomeprol-400 and 40 matched controls following the injection of either Ultravist-370 or Omnipaque-350. Arterial phase enhancement in Hounsfield units was measured at the abdominal aorta, proximal and distal deep inferior epigastric arteries (DIEAs), and DIEP. Although measurements were collected at the aorta, these were excluded from statistical analysis due to nonnormal distribution.

[RESULTS] Significant differences in arterial enhancement were found between the groups. The Iomeprol-400 group showed higher enhancement at the proximal DIEA ( < 0.001), distal DIEA ( = 0.004), and at the DIEP ( < 0.001).

[CONCLUSIONS] Iomeprol-400 significantly improves visualization of critical small-diameter vessels in preoperative CTA for DIEP flap surgery compared with Ultravist-370 and Omnipaque-350. These findings support incorporating higher iodine concentration agents such as Iomeprol-400 into preoperative imaging protocols for DIEP flap surgery.