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The deep inferior epigastric artery perforator (DIEAP) flap is the mostcommon free flap used for breast reconstruction after a mastectomy. It makesuse of the skin and fat of the lower abdomen to build a new breast mound eitherat the same time of the mastectomy or in a second surgery. This operationrequires preoperative imaging studies to evaluate the branches - theperforators - that irrigate the tissue that will be used to reconstruct thebreast mound. These branches will support tissue viability after themicrosurgical ligation of the inferior epigastric vessels to the receptorvessels in the thorax. Usually through a Computed Tomography Angiography (CTA),each perforator, diameter and direction is manually identified by the imagingteam, who will subsequently draw a map for the identification of the bestvascular support for the reconstruction. In the current work we propose asemi-automatic methodology that aims at reducing the time and subjectivityinherent to the manual annotation. In 21 CTAs from patients proposed for breastreconstruction with DIEAP flaps, the subcutaneous region of each perforator wasextracted, by means of a tracking procedure, whereas the intramuscular portionwas detected through a minimum cost approach. Both were subsequently comparedwith the radiologist manual annotation. Results showed that the semi-automaticprocedure was able to correctly detect the course of the DIEAPs with a minimumerror (average error of 0.64 mm and 0.50 mm regarding the extraction ofsubcutaneous and intramuscular paths, respectively). The objective methodologyis a promising tool in the automatic detection of perforators in CTA and cancontribute to spare human resources and reduce subjectivity in theaforementioned task.

Computer Aided Detection of Deep Inferior Epigastric Perforators in Computed Tomography Angiography scans