Division of Interventional Radiology, Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California.
Division of Interventional Radiology, Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California.
J Vasc Interv Radiol. 2023 Nov;34(11):1861-1867. doi: 10.1016/j.jvir.2023.07.033. Epub 2023 Aug 11.
To evaluate if the addition of cone-beam computed tomography (CT) to digital subtraction angiography (DSA) improves the identification of the genicular arteries during genicular artery embolization (GAE) for knee pain secondary to osteoarthritis (OA).
This single-center study retrospectively analyzed 222 patients who underwent GAE for painful knee OA between May 2018 and April 2022. Intraprocedural cone-beam CT and DSA images were reviewed independently by 2 sets of interventional radiologists. DSA was performed for all patients. Technically adequate cone-beam CT was available for 205 patients (92.3%). The presence of the genicular arteries identified by cone-beam CT and DSA was compared using Φ coefficients. Embolization targets identified by both cone-beam CT and DSA were evaluated against those identified by DSA alone.
Genicular arteries with the highest concordance between cone-beam CT and DSA were the inferior lateral (196 vs 198; Φ = 0.3530; P < .0001), superior lateral (197 vs 200; Φ = 0.3060; P < .0001), and superior medial genicular (186 vs 161; Φ = 0.2836; P < .0001) arteries. Cone-beam CT demonstrated higher rates of detection of the inferior medial (195 vs 178; Φ = 0.04573; P = .5150) and median genicular arteries (200 vs 192; Φ = 0.04573; P = .5150). Meanwhile, genicular arteries less frequently identified by cone-beam CT were the descending genicular (197 vs 200; Φ = -0.03186; P = .6502), superior patellar (175 vs 184; Φ = 0.1332; P = .0569), and recurrent anterior tibial (156 vs 186; Φ = 0.01809; P = .7969) arteries. Cone-beam CT in combination with DSA identified 13.4% (372 vs 328) more targets compared to DSA alone.
Based on the results of the current study, cone-beam CT serves as a valuable adjunct for visualizing the genicular arteries during GAE, and together with DSA, it identifies more potential embolization targets.
评估在膝关节骨性关节炎（OA）引起的膝关节疼痛的膝关节动脉栓塞术（GAE）中，锥形束 CT（CBCT）是否能提高对关节动脉的识别。
本单中心研究回顾性分析了 2018 年 5 月至 2022 年 4 月期间接受 GAE 治疗的 222 例膝关节 OA 疼痛患者。由两组介入放射科医生分别对术中 CBCT 和 DSA 图像进行独立评估。所有患者均行 DSA 检查。205 例患者（92.3%）获得了可评估的术中 CBCT 图像。使用Φ系数比较 CBCT 和 DSA 识别的关节动脉的存在。比较 CBCT 和 DSA 共同识别的栓塞靶点与 DSA 单独识别的栓塞靶点。
在 CBCT 和 DSA 之间具有最高一致性的关节动脉是下外侧（196 对 198；Φ=0.3530；P<0.0001）、上外侧（197 对 200；Φ=0.3060；P<0.0001）和上内侧关节动脉（186 对 161；Φ=0.2836；P<0.0001）。CBCT 显示出更高的下内侧（195 对 178；Φ=0.04573；P=0.5150）和中间关节动脉（200 对 192；Φ=0.04573；P=0.5150）的检测率。同时，CBCT 较少识别的关节动脉是下降支（197 对 200；Φ=-0.03186；P=0.6502）、髌骨上支（175 对 184；Φ=0.1332；P=0.0569）和胫骨前返支（156 对 186；Φ=0.01809；P=0.7969）。与 DSA 相比，CBCT 联合 DSA 可识别出 13.4%（372 对 328）更多的潜在栓塞靶点。
根据本研究的结果，CBCT 可作为 GAE 中可视化关节动脉的一种有价值的辅助手段，与 DSA 一起可识别出更多潜在的栓塞靶点。
