Magnetic Resonance-Digital Subtraction Angiography as a Preprocedural Imaging Modality before Transcatheter Arterial Microembolization for Chronic Musculoskeletal Pain.

Abstract

Purpose: This retrospective study evaluated the potential utility and accuracy of magnetic resonance digital subtraction angiography (MR-DSA) as a preoperative imaging modality for transcatheter arterial microembolization (TAME) in musculoskeletal pain management, compared to conventional digital subtraction angiography (DSA).

Materials and methods: Eleven patients with various musculoskeletal conditions underwent MR-DSA and DSA before TAME. Image evaluation was performed on 33 regions of interest (ROIs) across 11 patients. Three experienced readers evaluated abnormal stains using a 4-point scale (0-3). Inter-observer agreements were analyzed using kappa statistics. Sensitivity and specificity of MR-DSA were calculated using DSA as the reference standard. Pain scores (NRS) were obtained pre-TAME and 1 month post-TAME.

Results: Inter-observer agreement was substantial for DSA (κ=0.66) and MR-DSA (κ=0.73). MR-DSA showed high sensitivity (1.0) and moderate specificity (0.64) for detecting abnormal stains, with DSA as the reference standard. The pain score decreased by an average of 2.6 on the NRS. Although lesions that were positive on both MR-DSA and DSA tended to show greater pain reduction, this correlation was not statistically significant.

Conclusion: MR-DSA is a highly sensitive preoperative imaging modality that can detect abnormal vascular stains associated with musculoskeletal pain. However, its clinical utility remains uncertain, and further large-scale studies are required before drawing definitive conclusions.