Prognostication of Three-Month Genicular Artery Embolization Outcomes Using Pre-Procedural MRIs

Area of Science:

• Orthopedics
• Interventional Radiology
• Medical Imaging

Background:

• Symptomatic knee osteoarthritis (KOA) poses a significant clinical challenge.
• Genicular artery embolization (GAE) is an emerging treatment for KOA.
• Predicting treatment response to GAE is crucial for patient management.

Purpose of the Study:

• To evaluate the prognostic value of pre-procedural knee magnetic resonance imaging (MRI) for early outcomes following GAE in patients with KOA.
• To identify specific MRI-detectable structural abnormalities that correlate with treatment response.

Main Methods:

• A single-center study analyzed 39 patients undergoing GAE with pre-procedural MRIs.
• MRIs were assessed for structural abnormalities (menisci, ligaments, cartilage, marrow, loose bodies) and synovitis.
• Clinical outcomes were measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at baseline and three months post-GAE.
• Categorical response was defined as a 50% reduction in WOMAC pain scores.

Main Results:

• A 34.6% clinical response rate was observed.
• Pre-procedural lateral meniscus and cartilage abnormalities predicted a poor categorical response at three months (P=0.039-0.040).
• Four or more structural abnormalities (P=0.004) and Kellgren-Lawrence grade ≥3 (P<0.001) were associated with poor treatment outcomes.
• Synovitis was not predictive of response (P=0.809).
• Temporary embolic agents showed a lower adverse event rate than permanent agents (P=0.032).

Conclusions:

• Pre-procedural knee MRI demonstrates short-term prognostic utility for GAE in KOA.
• Abnormalities in the lateral meniscus and cartilage on pre-GAE MRI are indicators of a potentially poor response to treatment.
• A higher burden of structural knee abnormalities correlates with diminished treatment success.
• Temporary embolic agents may offer a safer profile compared to permanent agents in GAE procedures.