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

Abstract

Purpose

To retrospectively evaluate the potential utility and accuracy of magnetic resonance (MR)–digital subtraction angiography (DSA) as a preprocedural imaging modality for transcatheter arterial microembolization (TAME) in musculoskeletal pain management, compared with conventional 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 across 11 patients. Three experienced readers evaluated abnormal enhancement (stains) using a 4-point scale (0–3). Interobserver agreements were analyzed using kappa statistics. Sensitivity and specificity of MR-DSA were calculated using DSA as the reference standard. Pain scores (numerical rating scale [NRS]) were obtained before TAME and 1 month after TAME.

Results

Interobserver 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 enhancement, with DSA as the reference standard. The pain score decreased by a mean 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.

Conclusions

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