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DIEP CTA Report Assistant

Deep inferior epigastric perforator CTA for breast reconstruction — fill each side and the dictation builds below.

Before dictating — Pre-3D Lab steps

On thin axial images, mark the perforating artery locations where they exit the rectus sheath — only vessels >1.5 mm. Mark on both axial and coronal; name them R1, R2, L1, L2.
Notify the 3D Lab that you have marked the perforators.
Wait for the 3D Lab reformats and umbilicus-distance measurements, then QC them (errors are common).
Dictate below (CTA DIEP template, Body Templates).

Findings by side

up to 2 perforators each · medial & short segments preferred

Report (copy to PowerScribe DIEP template)

Workflow, anatomy & pearls

Workflow

On thin axials, mark the perforators (only vessels >1.5 mm) where they exit the rectus sheath — the 2 best on each side. Name them R1, R2, L1, L2 (mark on axial and coronal).
Notify the 3D Lab; wait for reformats and umbilicus-distance measurements.
QC the 3D Lab measurements (errors are common): find the marked perforator on axials, use scout/localizer to find it on coronals, locate the umbilicus, and confirm the distance matches the "skin view" measurement.
Dictate with the DIEP template (Body Templates).

CTA protocol (differs from a standard CT abd/pelvis CTA)

Use the dedicated DIEP button. Scan caudal to cranial; bolus-track with the ROI/trigger on the common femoral artery; fixed contrast dose 150 cc. 3D Lab reformats: thick MIPs showing each DIEA origin from the distal external iliac, coronal and sagittal slabs labeled R/L, and skin views (with grid) to give distance from the umbilicus.

Anatomy — pedicle has up to 5 segments

(1) DIEA deep to rectus, (2) DIEA within rectus (intramuscular), (3) intramuscular segment of the perforator, (4) subfascial segment, (5) subcutaneous segment. Longer intramuscular and subfascial segments increase the risk of pedicle injury during dissection.

Branching pattern (DIEA)

Type 1 = single vessel · Type 2 = bifurcated · Type 3 = trifurcated.

Why these preferences

Medial perforators are preferred — a lateral perforator dissection may damage the nerve innervating the rectus. Short intramuscular/subfascial courses are preferred — they are easier and safer to dissect.

Anatomy/technique: Lam DL, Mitsumori LM, Neligan PC, et al. Br J Radiol 2012. Workflow per DHMC Body "DIEP How To."