Singh R, Makary MS. Multimodality imaging considerations for genicular artery embolization in knee osteoarthritis. World J Radiol 2026; 18(6): 120315 [DOI: 10.4329/wjr.120315]
Corresponding Author of This Article
Mina S Makary, MD, Doctor, Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Medical Center, 395 W. 12th Ave. 4th Floor Faculty Office Tower, Columbus, OH 43210, United States. mina.makary@osumc.edu
Research Domain of This Article
Radiology, Nuclear Medicine & Medical Imaging
Article-Type of This Article
review-article
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World J Radiol. Jun 28, 2026; 18(6): 120315 Published online Jun 28, 2026. doi: 10.4329/wjr.120315
Multimodality imaging considerations for genicular artery embolization in knee osteoarthritis
Ramanpreet Singh, Mina S Makary
Ramanpreet Singh, College of Medicine, Northeast Ohio Medical University, Rootstown, OH 44272, United States
Mina S Makary, Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Medical Center, Columbus, OH 43210, United States
Author contributions: Singh R and Makary MS contributed to the study conception and design, writing-review and editing of the manuscript, commented on previous versions of the manuscript; Singh R contributed to visualization of manuscript; Makary MS contributed to supervision of manuscript, administered the project; and all authors read and approved of the final manuscript.
Conflict-of-interest statement: Singh R and Makary MS declare no conflict of interests for this article.
Corresponding author: Mina S Makary, MD, Doctor, Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Medical Center, 395 W. 12th Ave. 4th Floor Faculty Office Tower, Columbus, OH 43210, United States. mina.makary@osumc.edu
Received: February 24, 2026 Revised: April 7, 2026 Accepted: April 20, 2026 Published online: June 28, 2026 Processing time: 122 Days and 7.9 Hours
Abstract
Genicular artery embolization (GAE) describes a minimally invasive, catheter-directed therapy that targets abnormal hypervascular synovium and periarticular neovessels in patients with symptomatic knee osteoarthritis (OA), particularly those with inflammation-predominant disease who are poor surgical candidates or wish to defer arthroplasty. As clinical adoption expands, pre-, intra-, and post-procedure imaging has become increasingly relevant to both diagnostic and interventional radiologists. In practical terms, inflammation-predominant disease refers to knees with prominent synovitis-related magnetic resonance imaging (MRI) findings despite less advanced irreversible structural destruction, whereas structure-predominant disease is characterized by extensive cartilage loss, large bone marrow lesions, meniscal maceration, and advanced radiographic degeneration. Although no prospectively validated imaging cutoff exists for routine GAE candidate selection, current studies suggest that moderate-to-large effusion-synovitis (the combined appearance of joint fluid and synovial thickening on non-contrast MRI) (grade 2-3), greater overall MRI lesion burden (≥ 4 abnormalities), and extensive full-thickness cartilage loss may help distinguish these phenotypes. Synovial enhancement and effusion-synovitis on MRI are the findings most consistently expected to improve, whereas structural hallmarks of OA often persist and may be misinterpreted as treatment failure. Early marrow or subchondral signal alterations have also been reported after embolization and require cautious follow-up interpretation. This review summarizes contemporary evidence on pre-, intra-, and post-procedure imaging, semiquantitative MRI scoring systems, and common post-GAE interpretive pitfalls.
Core Tip: Genicular artery embolization (GAE) is increasingly used for inflammation-predominant knee osteoarthritis, making accurate post-procedure imaging interpretation essential. This review summarizes expected magnetic resonance imaging (MRI) and radiographic findings after GAE, emphasizes that inflammatory features (synovial enhancement and effusion-synovitis) are the most consistent imaging response signals, and highlights pitfalls in overcalling persistent structural osteoarthritis findings (osteophytes, cartilage defects, joint space narrowing) as treatment failure. Semiquantitative MRI scoring systems used in published GAE studies are reviewed to support consistent assessment and follow-up.
