Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Dec 1;13(12):7719-7730.
doi: 10.21037/qims-23-490. Epub 2023 Sep 12.

Efficacy and reliability of three-dimensional fusion guidance for fluoroscopic navigation in transarterial embolization for refractory musculoskeletal pain

Lung-Hui Chiang  1   2 , Ya-Che Chen  1   2 , Guo-Shu Huang  1   2   3 , Ting-Fu Huang  1   2 , Yung-Chih Sun  1   2 , Wei-Chou Chang  1   2 , Yi-Chih Hsu  1   2
Affiliations

Efficacy and reliability of three-dimensional fusion guidance for fluoroscopic navigation in transarterial embolization for refractory musculoskeletal pain

Lung-Hui Chiang et al. Quant Imaging Med Surg. .

Abstract

Background: This study aimed to evaluate the efficacy and reliability of three-dimensional (3D) fusion guidance in roadmapping for fluoroscopic navigation during trans-arterial embolization for refractory musculoskeletal pain (TAE-MSK pain) in the extremities.

Methods: The included research patients were divided into two groups: group A-TAE-MSK pain performed without the use of 3D fusion guidance; group B-TAE-MSK pain performed with the use of 3D fusion guidance for fluoroscopic navigation. We compared the procedure time, radiation dose, visual analogue scale for pain scores, and adverse effects (before and 3 months after TAE-MSK pain) among the two groups. In the group B, we determined the reliability of ideal branch angle for pre-operative non-contrast 3D magnetic resonance angiography (MRA) and intra-operative 3D cone beam computed tomography (CBCT) angiography.

Results: We recruited 65 patients, including 23 males and 42 females (average age 58.20±12.58 years), with 38 and 27 patients in groups A and B. A total of 247 vessels were defined as target branch vessels. Significant changes were observed in the fluoroscopy time which was 32.31±12.39 and 14.33±3.06 minutes, in group A and group B (P<0.001), respectively; procedure time, which was 46.45±17.06 in group A and 24.67±9.78 in group B (P<0.001); and radiation exposure dose, determined as 0.71±0.64 and 0.34±0.29 mSv (P<0.01) in group A and group B, respectively. Furthermore, the number of target branch vessels, that underwent successful catheterization were 107 (97%) in group B as compared to 96 (70%) in group A, which was also significant (P<0.001). The study also showed that the ideal branch-angle has a similarly high consistency in pre-operative and intra-operative angiography based on the intra-class correlation coefficient (ICC) (0.994; 0.990, respectively).

Conclusions: 3D fusion guidance for fluoroscopic navigation not only is a reliable process, but also effectively reduces the operation time and radiation dose of TAE-MSK pain.

Keywords: Angiography; fluoroscopic navigation; magnetic resonance; musculoskeletal pain; trans-arterial embolization.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://qims.amegroups.com/article/view/10.21037/qims-23-490/coif). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flowchart illustrating patient selection for the study. TAE, transarterial embolization; MSK, musculoskeletal; CBCT, cone bean computed tomography; MRA, magnetic resonance angiography.
Figure 2
Figure 2
The three-dimensional image fusion techniques used in fluoroscopic navigation. The processes for the pre-operative non-contrast 3D MRA and 3D CBCT angiography for 3D image fusion used in fluoroscopic navigation among group B patients. The 3D image was rotated in the workstation to obtain the easiest separation angle between the target vessel and the main trunk. The workflow indicates how the ideal target branch vessel was separated from main trunk artery on the 3D workstation and the saved key 2D reference image. White arrows indicate target vessels. Group B: TAE-MSK pain performed with the use of 3D fusion guidance for fluoroscopic navigation. MRA, magnetic resonance angiography; OP, operative; LAO, left anterior oblique; DSA, digital subtraction angiography; CBCT, cone bean computed tomography; CT, computed tomography; CBCTA, cone bean computed tomography angiography.
Figure 3
Figure 3
Evaluating the reliability of image fusion for fluoroscopic navigation based on the measurement of the included angle before and after fusion. (Remarks: the measurement method is based on the angle between the long axis of the main vessel wall and the long axis of the target branch vessel as the measurement benchmark). Black arrows and white arrows: target branch vessel. Ө1: angle measured in the key 2D reference image; Ө2: angle measured after fusion of 2D reference image and roadmap image. MRA, magnetic resonance angiography; CBCT, cone bean computed tomography.
Figure 4
Figure 4
Case example. A 70-year-old female, with history of refractory right knee pain after total knee arthroplasty one year ago and underwent TAE. The 3D-CBCT angiography image revealed the target branch vessel—medial superior genicular artery, the orifice of which was invisible due to overlapping and being obscured by the metal implant used in the total knee arthroplasty at anteroposterior projection (A). The target branch vessel can be separated from popliteal artery and is clearly visible at the best viewing angle (LAO 105°/CRAN 90°) on adjusting the 3D-CBCT angiography image at the workstation (B). After 3D fusion guidance for fluoroscopic navigation, the target branch vessel can be identified without overlapping on roadmap image at the automatic gantry position (C). Successful catheterization of the target branch vessel on digital subtraction image at anteroposterior projection (D). Thin white arrow: target vessel; thick white arrow: metal implant. TAE, transarterial embolization; CBCT, cone bean computed tomography; LAO, left anterior oblique; CRAN, cranial.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Okuno Y, Matsumura N, Oguro S. Transcatheter arterial embolization using imipenem/cilastatin sodium for tendinopathy and enthesopathy refractory to nonsurgical management. J Vasc Interv Radiol 2013;24:787-92. 10.1016/j.jvir.2013.02.033 - DOI - PubMed
    1. Little MW, Gibson M, Briggs J, Speirs A, Yoong P, Ariyanayagam T, Davies N, Tayton E, Tavares S, MacGill S, McLaren C, Harrison R. Genicular artEry embolizatioN in patiEnts with oSteoarthrItiS of the Knee (GENESIS) Using Permanent Microspheres: Interim Analysis. Cardiovasc Intervent Radiol 2021;44:931-40. 10.1007/s00270-020-02764-3 - DOI - PMC - PubMed
    1. Torkian P, Golzarian J, Chalian M, Clayton A, Rahimi-Dehgolan S, Tabibian E, Talaie R. Osteoarthritis-Related Knee Pain Treated With Genicular Artery Embolization: A Systematic Review and Meta-analysis. Orthop J Sports Med 2021;9:23259671211021356. 10.1177/23259671211021356 - DOI - PMC - PubMed
    1. Bagla S, Piechowiak R, Hartman T, Orlando J, Del Gaizo D, Isaacson A. Genicular Artery Embolization for the Treatment of Knee Pain Secondary to Osteoarthritis. J Vasc Interv Radiol 2020;31:1096-102. 10.1016/j.jvir.2019.09.018 - DOI - PubMed
    1. Hwang JH, Park SW, Kim KH, Lee SJ, Oh KS, Chung SW, Moon SG. Early Results of Transcatheter Arterial Embolization for Relief of Chronic Shoulder or Elbow Pain Associated with Tendinopathy Refractory to Conservative Treatment. J Vasc Interv Radiol 2018;29:510-7. 10.1016/j.jvir.2017.11.013 - DOI - PubMed