Effect of Nitroglycerin-Enhanced Dual-Energy CT on Imaging Periarticular Arteries in Knee Osteoarthritis: A Prospective Observational Study.

RATIONALE AND

OBJECTIVES

Accurate visualization of periarticular arteries is crucial for vascular evaluation in knee osteoarthritis (KOA), which often entails complex vascular changes. This study aims to assess the impact of dual-energy computed tomography (DECT) combined with sublingual nitroglycerin (NTG) on the imaging quality of computed tomographic angiography (CTA) in KOA patients.

MATERIALS AND

METHODS

A prospective observational study was conducted, from January 2024 to October 2024, involving 60 patients with KOA. Participants were divided into two groups: one receiving NTG (n = 30) and a control without NTG (n = 30). Lower-limb CTA was performed using DECT, and 40-keV virtual monochromatic images (VMI) were reconstructed. Evaluation metrics included contrast-to-noise ratio (CNR), arterial diameters, overall image quality, and the number of visible periarticular arteries.

RESULTS

NTG administration significantly increased arterial diameters, with the popliteal artery measuring 5.06 ± 0.92 mm vs 5.98 ± 0.84 mm (P < .001) and the middle genicular artery from 0.79 ± 0.27 mm to 1.06 ± 0.30 mm (P < .001). The visualization rate of smaller arteries improved, notably the medial inferior genicular artery from 51.6% to 78.3% (P < .001). Overall image quality scores and CNR were higher in the NTG group (4.77 ± 0.54 vs 3.83 ± 0.73, P < .001; 77.87 ± 21.89 vs 50.25 ± 15.27, P = .002).

CONCLUSION

Combining sublingual NTG with 40-keV virtual monochromatic DECT enhances arterial visualization and imaging quality, especially for smaller vessels, indicating potential benefits for preoperative vascular evaluation in KOA management.