Added Value of Cone-Beam CT to Identify Arterial Supply during Genicular Artery Embolization for Knee Osteoarthritis

Purpose: 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). Materials and Methods: 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 Phi coefficients. Embolization targets identified by both cone-beam CT and DSA were evaluated against those identified by DSA alone. Results: Genicular arteries with the highest concordance between cone-beam CT and DSA were the inferior lateral (196 vs 198; Phi = 0.3530; P < .0001), superior lateral (197 vs 200; Phi = 0.3060; P < .0001), and superior medial genicular (186 vs 161; Phi = 0.2836; P < .0001) arteries. Cone-beam CT demonstrated higher rates of detection of the inferior medial (195 vs 178; Phi = 0.04573; P = .5150) and median genicular arteries (200 vs 192; Phi = 0.04573; P = .5150). Meanwhile, genicular arteries less frequently identified by cone-beam CT were the descending genicular (197 vs 200; Phi = -0.03186; P = .6502), superior patellar (175 vs 184; Phi = 0.1332; P = .0569), and recurrent anterior tibial (156 vs 186; Phi = 0.01809; P = .7969) arteries. Cone -beam CT in combination with DSA identified 13.4% (372 vs 328) more targets compared to DSA alone. Conclusions: 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.