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

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.