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Purpose <p>Transarterial embolization (TAE) for adhesive capsulitis requires precise detection of periarticular neovascularization, which is often inconspicuous on digital subtraction angiography (DSA). This study compared intra-arterial CT angiography (IA-CTA) with DSA for detecting synovial neovascularization during embolization.</p> Materials and Methods <p>In this prospective single-center study, 21 participants with adhesive capsulitis despite ≥ 3&#xa0;months of conservative treatment were enrolled. Nonselective IA-CTA was performed from the mid-subclavian artery before selective DSA-guided embolization in a hybrid angio-CT suite. Six periarticular sites per shoulder were evaluated. Two radiologists independently assigned five-point scores for IA-CTA and DSA to establish the reference standard using a multimodality adjudication rule. Six radiology residents independently scored each modality. Diagnostic performance was compared using multireader multicase analysis; secondary endpoints were sensitivity, specificity, and reader agreement.</p> Results <p>Twenty-one participants (mean age, 61.6 ± 11.0&#xa0;years; 15 women, 6 men) were included. Of 126 periarticular sites, 65 (51.6%) were positive by the reference standard. Reader-averaged area under the receiver operating characteristic curve (AUC) favored IA-CTA over DSA (0.901 vs. 0.769; <i>p</i> &lt; 0.01). At the prespecified positivity threshold (score ≥ 4), reader-averaged sensitivity was 68.5% (95% CI: 57.0–79.7) with IA-CTA and 47.9% (95% CI: 36.9–57.7) with DSA (<i>p</i> = 0.01), whereas specificity was 95.4% (95% CI: 90.8–99.0) with IA-CTA and 92.3% (95% CI: 86.2–97.4) with DSA (<i>p</i> = 0.24). Inter-reader agreement favored IA-CTA over DSA (weighted κ 0.75 vs. 0.65; <i>p</i> &lt; 0.01).</p> Conclusion <p>Nonselective IA-CTA showed higher diagnostic performance, higher sensitivity, and better inter-reader agreement than selective DSA for detecting synovial neovascularization.</p> Level of Evidence <p>Level 4, diagnostic study. (ClinicalTrials.gov: NCT06509087)</p> Graphical abstract <p></p>

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Nonselective Intra-arterial CT Angiography Versus Selective Digital Subtraction Angiography for Detecting Neovascularization During Transarterial Embolization for Adhesive Capsulitis

  • 期刊论文

  • 发表日期：

    2026年7月29日

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  • Wei-Chen Liao,
  • Hao-Yu Huang,
  • Yu-Hsin Chen,
  • Han-Bin Huang,
  • Wen-Jinn Liaw,
  • Yi-Chih Hsu

摘要

Purpose

Transarterial embolization (TAE) for adhesive capsulitis requires precise detection of periarticular neovascularization, which is often inconspicuous on digital subtraction angiography (DSA). This study compared intra-arterial CT angiography (IA-CTA) with DSA for detecting synovial neovascularization during embolization.

Materials and Methods

In this prospective single-center study, 21 participants with adhesive capsulitis despite ≥ 3 months of conservative treatment were enrolled. Nonselective IA-CTA was performed from the mid-subclavian artery before selective DSA-guided embolization in a hybrid angio-CT suite. Six periarticular sites per shoulder were evaluated. Two radiologists independently assigned five-point scores for IA-CTA and DSA to establish the reference standard using a multimodality adjudication rule. Six radiology residents independently scored each modality. Diagnostic performance was compared using multireader multicase analysis; secondary endpoints were sensitivity, specificity, and reader agreement.

Results

Twenty-one participants (mean age, 61.6 ± 11.0 years; 15 women, 6 men) were included. Of 126 periarticular sites, 65 (51.6%) were positive by the reference standard. Reader-averaged area under the receiver operating characteristic curve (AUC) favored IA-CTA over DSA (0.901 vs. 0.769; p < 0.01). At the prespecified positivity threshold (score ≥ 4), reader-averaged sensitivity was 68.5% (95% CI: 57.0–79.7) with IA-CTA and 47.9% (95% CI: 36.9–57.7) with DSA (p = 0.01), whereas specificity was 95.4% (95% CI: 90.8–99.0) with IA-CTA and 92.3% (95% CI: 86.2–97.4) with DSA (p = 0.24). Inter-reader agreement favored IA-CTA over DSA (weighted κ 0.75 vs. 0.65; p < 0.01).

Conclusion

Nonselective IA-CTA showed higher diagnostic performance, higher sensitivity, and better inter-reader agreement than selective DSA for detecting synovial neovascularization.

Level of Evidence

Level 4, diagnostic study. (ClinicalTrials.gov: NCT06509087)

Graphical abstract