Division of Interventional Radiology, Department of Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois. Electronic address: https://twitter.com/walsterIR.
Division of Pain Management, Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois. Electronic address: https://twitter.com/MagdaAnitescuMD.
J Vasc Interv Radiol. 2023 Dec;34(12):2190-2196. doi: 10.1016/j.jvir.2023.08.041. Epub 2023 Sep 9.
To quantify perfusion changes during genicular artery embolization (GAE) with the qualitatively described "pruning" technique using parametric analysis.
A total of 12 patients underwent unilateral GAE with a total of 36 vessels embolized. Among 34 of the 36 vessels embolized, regions of interest (ROIs) were placed on parent vessels (PVs) and hyperemic target vessels (TVs) before and after GAE. For each ROI, peak intensity (PI), time to arrival (TTA), and area under the curve (AUC) were computed and compared between PV and TV. Volume of embolic administered was correlated with adverse events.
No change was seen in PI, TTA, and AUC in the PV after GAE. Reduction in AUC (1,495.7 ± 521.5 vs 1,667.4 ± 574.0; P << .01) and PI (195.1 ± 43.8 vs 224.3 ± 49.2; P << .01) with increase in TTA (3.42 s ± 1.70 vs 1.92 s ± 1.45; P << .01) within the TV were observed after GAE. Median follow-up time was 89 days (range, 21-254 days). Reduction in clinical symptoms was also noted based on the Western-Ontario and McMaster Universities Arthritis Index total and pain scale at 1 month (total, 42.9% ± 23.0; pain, 54.4% ± 9.8; P << .01) and 3 months (total, 42.5% ± 14.9; pain, 57.8% ± 10.6; P << .01). Eight total mild adverse events (minor/self-limiting) were noted per Society of Interventional Radiology guidelines. A larger volume of embolic was observed in knees with skin changes (3.4 mL ± 0.4 vs 1.7 mL ± 0.4; P << .001). Furthermore, all skin changes were seen with embolic volumes >3.0 mL.
Quantification of intraprocedural perfusion changes with GAE demonstrated reduced flow to the TV with maintained flow in the PV and acceptable clinical outcomes. A potential relationship between embolic volume and nontarget embolization was also highlighted.
使用参数分析，对使用定性描述的“修剪”技术进行的关节内动脉栓塞（GAE）过程中的灌注变化进行量化。
共对 12 名患者的 36 条单侧 GAE 血管进行了研究。在栓塞的 36 条血管中，有 34 条在栓塞前和栓塞后分别在母血管（PV）和充血靶血管（TV）上放置了感兴趣区域（ROI）。对于每个 ROI，计算并比较了 PV 和 TV 的峰值强度（PI）、到达时间（TTA）和曲线下面积（AUC）。栓塞体积与不良事件相关。
栓塞后，PV 的 PI、TTA 和 AUC 没有变化。在 TV 中，AUC（1,495.7 ± 521.5 比 1,667.4 ± 574.0；P <<.01）和 PI（195.1 ± 43.8 比 224.3 ± 49.2；P <<.01）减少，而 TTA（3.42 s ± 1.70 比 1.92 s ± 1.45；P <<.01）增加，观察到栓塞后 TV 内的 AUC（1,495.7 ± 521.5 比 1,667.4 ± 574.0；P <<.01）和 PI（195.1 ± 43.8 比 224.3 ± 49.2；P <<.01）减少。中位随访时间为 89 天（范围 21-254 天）。根据 Western-Ontario 和 McMaster 大学关节炎指数的总分和疼痛评分，在 1 个月（总分，42.9% ± 23.0%；疼痛，54.4% ± 9.8%；P <<.01）和 3 个月（总分，42.5% ± 14.9%；疼痛，57.8% ± 10.6%；P <<.01）时，临床症状也有所改善。根据介入放射学会的指南，共观察到 8 例总轻度不良事件（轻微/自限性）。在膝关节皮肤改变的患者中，观察到的栓塞体积较大（3.4 mL ± 0.4 比 1.7 mL ± 0.4；P <<.001）。此外，所有皮肤改变均发生在栓塞体积大于 3.0 mL 的情况下。
GAE 术中灌注变化的定量分析显示，TV 血流减少，而 PV 血流保持不变，临床结果可接受。还强调了栓塞体积与非目标栓塞之间的潜在关系。
