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Introduction: Interventional radiology (IR) is a rapidly developing speciality where innovation-especially in teaching practices-is vital. With workforce and capacity shortages, synthesis of classical educational theories and novel strategies utilising virtual reality (VR) and artificial intelligence (AI) provide opportunities to make teaching as efficient and effective as possible. The aim of this review is to examine the literature on different approaches in IR teaching and learning in undergraduates and postgraduates., Methods: Literature was reviewed using a comprehensive search strategy with relevant keywords. Articles were limited to 2013-2023. Databases searched included MEDLINE, Embase, British Education Index and ERIC, in addition to a manual review of references., Results: Of the 2903 unique abstracts reviewed by the authors, 43 were relevant to the purpose of this study. The major pedagogical approaches identified were categorised into the following-traditional master-apprentice mentoring, virtual reality/simulation, physical models, and remote teaching. VR simulations enable practise free from the limits of time and risk to patients, as well as potential for standardised formal curricula. AI has the capability to enhance training simulations and assessment of trainees. With recent events necessitating innovation in online remote teaching, programs that are accessible whilst arguably imparting just as much clinical knowledge as in-person education have now been developed., Conclusion: Mentoring has conventionally been the standard for radiology teaching, however there are now several alternative pedagogical approaches available to the IR community. A combination of the most effective ideas within each is the optimal method by which IR should be taught., (© 2024. The Author(s).)

Objective: To describe and study retrospectively the combination of elastic nails and cementoplasty to stabilize pathological fractures in the upper limb and present the results on pain and mobility., Materials and Methods: Between January 2022 and April 2024, six patients with a median age of 65 were treated with elastic nailing and cement injection. Pathological fractures were located in the clavicle (n = 3), humerus (n = 1) and radius (n = 2). Displacement at the fracture site was noted in two cases., Results: All nails were inserted successfully. Two nails were used for the humerus (n = 1) and the radius (n = 2), and a single nail was used for the clavicle (n = 3). A median volume of 6.5 cc of PMMA was injected. Median duration of the procedure was 155 min. Median pain score dropped from 8/10 the day before intervention to 3.5/10 at 10 days of follow-up and 3/10 at one-month follow-up. Three patients could move their upper limb without limitation. For the five patients for whom imaging was available, no fracture displacement was recorded at a median last follow-up of 3 months. There was no delayed complication., Conclusion: The combination of elastic nail and cementoplasty is feasible and allows to reduce pain and restore limb function. It may offer an alternative to patients suffering from pathological fractures in the upper limb and who are not candidates for surgery., (© 2024. Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE).)

Desmoid fibromatosis is a rare locally aggressive soft tissue tumor that is characterized as benign as it cannot metastasize. It was managed until recently like sarcomas, i.e with radical surgical resection combined or not with radiotherapy. However, this approach was associated with a high rate of recurrence and significant morbidity. The management of this disease has progressively changed to a more conservative approach given the fact that desmoid fibromatosis may spontaneously stop to grow or even shrink in more than half of the cases. Should treatment be required, recent guidelines recommend choosing between systemic therapies, which include principally chemotherapy and tyrosine kinase inhibitors, and local treatments. And this is where the interventional radiologist may have an important role to treat the disease. Various ablation modalities have been reported in the literature to treat desmoid fibromatosis, notably high-intensity focused ultrasound and cryoablation. Results are promising and cryoablation is now mentioned in recent guidelines. The interventional radiologist should nevertheless apprehend the disease in its globality to understand the place of percutaneous treatments among the other therapeutic options. The goal of this review is therefore to present and discuss the role of interventional radiology (IR) in the management of DF., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Institute of Radiology.)

The optimal treatment strategy for men with localised prostatic cancer of low and intermediate risk is an actively evolving field. It is important to strike a balance between maximal oncological control and minimal treatment-related complications, which helps preserve the patients' quality of life. MR-guided transurethral ultrasound ablation (TULSA) has emerged as a minimally invasive treatment option for this group of patients. This article aims to provide of a background on TULSA technology, a step-by-step procedural guide of MR-guided TULSA and to summarise the current evidence of TULSA in management of localised prostatic cancer, as well as other potential indications., (© 2024. Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE).)

Due to its rarity and non-specific clinical presentation, accurate diagnosis, and optimal therapeutic strategy of medullary thyroid carcinoma (MTC) remain challenging. Molecular imaging provides valuable tools for early disease detection, monitoring treatment response, and guiding personalized therapies. By enabling the visualization of molecular and cellular processes, these techniques contribute to a deeper understanding of disease mechanisms and the development of more effective clinical interventions. Different nuclear imaging techniques have been studied for assessing MTC, and among them, PET/CT utilizing multiple radiotracers has emerged as the most effective imaging method in clinical practice. This review aims to provide a comprehensive summary of the current use of advanced molecular imaging modalities, with a particular focus on PET/CT, for the management of patients with MTC. It aims to guide physicians towards a rationale for the use of molecular imaging also including theranostic approaches and novel therapeutical opportunities. Overall, we emphasize the evolving role of nuclear medicine in MTC. The integration of diagnostics and therapeutics by in vivo molecular imaging represents a major opportunity to personalize treatment for individual patients, with targeted radionuclide therapy being one representative example., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

In the last few decades, interventional radiology (IR) has significantly increased its role in the management of bone tumours including bone metastases (BM) that represent the most common type of tumour involving the bone. The current IR management of BM is based on the 'palliative-curative' paradigm and relies on the use of consolidative (i.e. osteplasty, osteosynthesis) and/or ablation (i.e. cryoablation, radiofrequency ablation, electrochemotherapy) techniques. The present narrative review will overview the current role of IR for the management of BM., (© 2023 Royal Australian and New Zealand College of Radiologists.)

In recent years, interventional radiologists have been increasingly involved in the management of bone fractures resulting from benign (osteoporosis and trauma), as well as malignant (tumor-related impending or pathologic fractures) conditions. Interventional techniques used to fix fractures include image-guided osteoplasty, screw-mediated osteosynthesis, or combinations of both. In the present narrative review, we highlight the most common clinical scenarios that may benefit from such interventional techniques with specific focus on spine, pelvic ring, and long bones., (© 2022. Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE).)

Study Objective: To evaluate the safety and clinical efficacy of percutaneous imaging-guided cryoablation for the management of anterior abdominal wall endometriosis., Design: Patients with abdominal wall endometriosis underwent percutaneous imaging-guided cryoablation and had a 6-month follow-up., Setting: Data dealing with patients' and anterior abdominal wall endometriosis (AAWE) characteristics, cryoablation, and clinical and radiologic outcomes were retrospectively collected and analyzed., Patients: Twenty-nine consecutive patients underwent cryoablation from June 2020 to September 2022., Interventions: Interventions were performed under US/computed tomography (CT) guidance or magnetic resonance imaging (MRI) guidance. Cryoprobes were directly inserted into the AAWE, and cryoablation was performed with a single 5 to 10 minute freezing cycle, which was stopped when the iceball expanded 3 to 5 mm beyond AAWE borders as assessed on intra-procedural cross-sectional imaging., Measurements and Main Results: Fifteen patients (15/29; 51.7%) had prior endometriosis, 28 (28/29; 95.5%) had previous cesarian section, and 22 (22/29; 75.9%) referred association between symptoms and menses. Cryoablation was performed under local (16/29; 55.2%) or general anesthesia (13/29; 44.8%) and mainly in an out-patient basis (18/20; 62%). There was only one (1/29; 3.5%) minor procedure-related complication. Complete symptom relief was recorded in 62.1% (18/29) and 72.4% (21/29) patients at 1 and 6 months, respectively. In the whole population, pain significantly dropped at 6 months compared to the baseline (1.1 ± 2.3; range 0-8 vs 7.1 ± 1.9; range 3-10; p <.05). Eight (8/29; 27.6%) patients presented residual symptoms at 6 months, and 4 (4/29; 13.8%) had an MRI-confirmed residual/recurring disease. Contrast-enhanced MRI obtained for the first 14 (14/29; 48.3%) patients of the series, all without signs of residual/recurring disease, demonstrated a significantly smaller ablation area compared to the baseline volume of the AAWE (1.0 cm 3 ± 1.4; range 0-4.7; vs 11.1 ± 9.9 cm 3 ; range 0.6-36.4; p <.05)., Conclusion: Percutaneous imaging-guided cryoablation of AAWE is safe and clinically effective in achieving pain relief., (Copyright © 2023 AAGL. Published by Elsevier Inc. All rights reserved.)

Purpose: To compare procedure-related variables, safety, renal function, and oncologic outcomes in patients undergoing percutaneous cryoablation (CA) of renal tumors with MRI- or CT-guidance., Materials and Methods: Patient, tumour, procedure, and follow-up data were collected and analysed. MRI and CT groups were matched using a coarsened exact approach according to patient's gender and age, tumour grade, size and location. P < 0.05 was considered statistically significant., Results: Two-hundred fifty-three patients (266 tumors) were retrospectively selected. Following the coarsened exact matching 46 patients (46 tumors) in the MRI group and 42 patients (42 tumors) in the CT group were matched. There were no significant baseline differences between the two populations except for the duration of follow-up (P = 0.002) and renal function (P = 0.002). On average MRI-guided CA lasted 21 min longer than CT-guided ones (P = 0.005). Following CA, complication rates (6.5% for MRI vs 14.3% for CT; P = 0.30) and GFR decline (mean - 13.1 ± 15.8%; range - 64.5-15.0 for MRI; mean - 8.1 ± 14.8%; range - 52.5-20.4; for CT; P = 0.13) were similar in both groups. The 5-year local progression-free, cancer-specific and overall survivals in the MRI and CT groups were 94.0% (95% CI 86.3%-100.0%) and 90.8% (95% CI 81.3%-100.0%; P = 0.55), 100.0% (95% CI 100.0%-100.0%) and 100.0% (95% CI 100.0%-100.0%; P = 1), and 83.7% (95% CI 64.0%-100.0%) and 76.2% (95% CI 62.0%-93.6%; P = 0.41), respectively., Conclusions: Apart from increased procedural times associated with MRI-guided CA of renal tumors compared to CT-guidance, both modalities demonstrate similar safety, GFR decline and oncologic outcomes., (© 2023. Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE).)

Purpose: To evaluate whether ablation volume difference relatively to tumoral volume, minimal distance between ablation area and necrotic tumor, or apparent diffusion coefficient (ADC) within the ablation area, measured on 1- and 3-month follow-up MRI following cryoablation of renal tumors, are associated with tumor recurrence., Materials and Methods: 136 renal tumors were retrospectively identified. Patients, tumor characteristics and follow-up MRI (1-, 3-, 6-month, and thereafter annually) were collected. Uni- and multivariate analyses were performed to assess the association between the investigated parameters and tumor recurrence., Results: Over the follow-up period (27.7 ± 21.9 months), 13 recurrences were identified at 20.5 ± 19.4 months. At 1- and 3-month, the mean volume difference between the ablation zone and the tumor volume were + 577.5 ± 511.3% vs + 251.4 ± 209.8% (p = 0.003), and + 268.8 ± 291.1% vs + 103.8 ± 94.6% (p = 0.023) in patients without and with tumor recurrence, respectively. At 1- and 3-month, the minimum distance between the necrotic tumor and the edge of the ablation area was 3.4 ± 2.5 vs 1.8 ± 1.9 mm (p = 0.019), and 2.4 ± 2.3 vs 1.4 ± 1.8 mm (p = 0.13) in patients without and with tumor recurrence, respectively. Analysis of ADC values was not associated with tumor recurrence. After performing the multivariate analysis, only volume difference of the ablation area compared to tumor volume was associated with absence of tumor recurrence at 1- (OR = 14.1; p = 0.001) and 3-month (OR = 8.2; p = 0.01)., Conclusions: Evaluation of volume difference between the ablation area and tumor volume on early (≤ 3 months) MRI follow-up identifies patients at risk of tumor recurrence., (© 2023. Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE).)

Pain is a common manifestation of several benign and malignant conditions. Inadequate response to conservative therapies is often succeeded by incremental use of analgesics and opioids; however, such an approach is often ineffective, not well tolerated by patients, and carries the risk of addiction leading to the opioid crisis. Implementing minimally invasive percutaneous procedures, performed by interventional radiologists has proven to be successful in providing safe, effective, and patient-specific therapies across a wide range of painful conditions. In the present narrative review, we will review the repertoire of minimally invasive imaging guided interventions, which have been successfully used to treat common painful benign and malignant conditions. We briefly describe each technique, common indications, and expected results., (Copyright © 2023 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.)

Painful benign bone tumors most commonly affect pediatric patients and young adults. They may be associated with skeletal-related events such as intractable pain, pathologic fracture, neurologic deficit as a consequence of nerve or spinal cord compression, as well as growth disturbance. Consequently, they often result in diminished activity and adversely affect quality of life. There have been substantial recent advances in percutaneous minimally invasive image-guided interventions for treatment of painful benign bone tumors including thermal ablation (radiofrequency ablation, cryoablation, microwave ablation, laser photocoagulation, and high-intensity focused US ablation), chemical (alcohol) ablation, cementoplasty, and intralesional injections. The safety, efficacy, and durability of such interventions have been established in the recent literature and as such, the role of musculoskeletal interventional radiologists in the care of patients with benign bone lesions has substantially expanded. The treatment goal of minimally invasive musculoskeletal interventions in patients with benign bone tumors is to achieve definitive cure. The authors detail the most recent advances and available armamentarium in minimally invasive image-guided percutaneous interventions with curative intent for the management of benign bone tumors. © RSNA, 2022.

Purpose: The purpose of this study was to report the technical feasibility and outcomes of percutaneous image-guided cryoablation with temporary balloon occlusion of the renal artery for the treatment of central renal tumors., Materials and Methods: All consecutive patients with central renal tumors treated with cryoablation and temporary renal artery occlusion from January 2017 to October 2021 were retrospectively included. Patient demographics, tumor's characteristics, procedural data, technical success, primary and secondary clinical efficacy, complications (according to Cardiovascular and Interventional Radiology Society of Europe [CIRSE] classification) and follow-up were investigated., Results: A total of 14 patients (8 men, 6 women; mean age 72.4 years ± 21.4 [SD] years; age range: 42-93 years) with 14 central renal tumors (median size, 32 mm; IQR: 23.5, 39.5 mm; range: 13-50 mm) were treated with percutaneous image-guided cryoablation and temporary balloon occlusion of the renal artery. Technical success was 13/14 (93%), with 1/14 (7%) failure of vascular access. A median of 4 cryoprobes (IQR: 3, 4.75) were inserted and protective hydrodissection was performed in 11/14 (79%) patients. Median time to perform cryoprobes insertion, hydrodissection and vascular access was 26.5 min (IQR: 18, 35 min), 10 min (IQR: 10, 17 min) and 30 min (IQR: 20, 45 min) respectively. Median duration of the whole intervention was 150 min (IQR: 129, 180 min; range: 100-270 min). Median hospital stay was 2.5 days (IQR: 2, 4 days; range: 2-14 days). Major complications occurred in 3/14 (21%) patients. Primary efficacy rate was 93% (13/14 patients). Median oncological follow-up was 25 months (IQR: 11, 33 months; range: 6-39 months). One patient experienced renal tumor recurrence at 14-months of follow-up, which was successfully treated with repeat cryoablation., Conclusion: Percutaneous image-guided cryoablation of renal tumors with temporary balloon occlusion of the renal artery is technically feasible, with a high technical success rate and paths the way for percutaneous treatment of central renal tumors., (Copyright © 2022 Société française de radiologie. Published by Elsevier Masson SAS. All rights reserved.)

Substantial advances in percutaneous image-guided minimally invasive musculoskeletal oncologic interventions offer a robust armamentarium for interventional radiologists for management of cancer. The authors outline the most recent advances in such interventions and the role of interventional radiologists in managing cancer in modern-era practice. Percutaneous minimally invasive musculoskeletal interventions including thermal ablation, cementation with or without osseous reinforcement by implants, osteosynthesis, neurolysis, and embolization, as well as palliative injections, have been successfully used by interventional radiologists to achieve durable, timely, safe, effective palliation in a multidisciplinary setting and have been progressively incorporated into the management paradigm for patients with cancer with musculoskeletal involvement. Familiarity with the described interventions and implementation of procedural safety measures, combined with integration of these procedures into clinical practice with the support of the National Comprehensive Cancer Network and the American College of Radiology, as well as continued technologic advances in procedural equipment design, will further enhance the role of interventional radiologists in cancer management. © RSNA, 2022.

Aim: To evaluate the effective spread of image-guided thermal ablation in thyroid gland and to characterize its current perceptions among European interventional radiologists., Materials and Methods: A questionnaire with 29 multiple choice questions about thyroid ablation was sent as an E-blast to 4752 CIRSE members. Only those who completed the survey in all its parts were included in the study., Results: 242/4752 (5.09%) participants (212 males and 30 females) completed and submitted the survey. A total of 160 subjects (66.1%) were familiar with any image-guided thermal ablations, but only 63 (26% of total population) usually perform thermal ablation for thyroid gland. Only 19.5% of the interviewed sample treats micropapillary thyroid tumours and the vast majority routinely uses radiofrequency ablation (84.4%)., Conclusion: There is a significant mismatch between thyroid ablation as reported by the literature and the relatively low percentage of interventional radiology actively performing such procedure in Europe. A considerable effort is required by the Cardiovascular and Interventional Radiological Society of Europe to fill this lack., (© 2022. Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE).)

Background: The COVID-19 pandemic had an unprecedented impact on clinical practice and healthcare professionals. We aimed to assess how interventional radiology services (IR services) were impacted by the pandemic and describe adaptations to services and working patterns across the first two waves., Methods: An anonymous six-part survey created using an online service was distributed as a single-use web link to 7125 members of the Cardiovascular and Interventional Radiological Society of Europe via email. Out of 450 respondents, 327 who completed the survey at least partially including 278 who completed the full survey were included into the analysis., Results: Interventional radiologists (IRs) reported that the overall workload decreased a lot (18%) or mildly (36%) or remained stable (29%), and research activities were often delayed (30% in most/all projects, 33% in some projects). Extreme concerns about the health of families, patients and general public were reported by 43%, 34% and 40%, respectively, and 29% reported having experienced significant stress (25% quite a bit; 23% somewhat). Compared to the first wave, significant differences were seen regarding changes to working patterns, effect on emergency work, outpatient and day-case services in the second wave. A total of 59% of respondents felt that their organisation was better prepared for a third wave. A total of 19% and 39% reported that the changes implemented would be continued or potentially continued on a long-term basis., Conclusion: While the COVID-19 pandemic has negatively affected IR services in terms of workload, research activity and emotional burden, IRs seem to have improved the own perception of adaptation and preparation for further waves of the pandemic., (© 2022. The Author(s).)

Purpose: To determine the oncologic outcomes and safety profile of image-guided percutaneous cryoablation (PCA) for extraspinal thyroid cancer bone metastases with curative intent., Materials and Methods: Between January 2010 and January 2020, 16 consecutive patients (8 men, 8 women; mean age, 61 years ± 19; range, 30-84 years) with 18 bone metastases (median bone tumor size, 19 mm; interquartile range [IQR], 12-29 mm; range, 7-58 mm) underwent PCA of oligometastatic extraspinal bone metastases. Thirteen (81%) patients were radioiodine therapy resistant. Two patients underwent 2 bone tumor ablations in a single session. Procedural data, oncologic outcomes, follow-up (with magnetic resonance imaging and positron emission tomography-computed tomography), and adverse events were retrospectively investigated. Local tumor progression-free survival, disease-free survival, and overall survival were estimated using the Kaplan-Meier method., Results: A median of 2 cryoprobes (IQR, 1.25-3 cryoprobes; range, 1-7 cryoprobes) were used, with 2 freezing cycles; the median length of freezing was 20 minutes (IQR, 17-20 minutes; range, 10-20 minutes). The technical success was 100% (18/18), and the primary technical efficacy was 94.4% (17/18). The median follow-up was 68 months (IQR, 38-93 months). During follow-up, 3 of 17 (17.6%) tumors demonstrated local progression at 7, 13, and 27 months. Consequently, the 1-, 2-, 3-, 4-, and 5-year local tumor progression-free survivals were 93.3%, 84.6%, 76.9%, 75%, and 72.7%, respectively. Two of 16 (12.5%) patients died during follow-up at 43 and 88 months. The major adverse event rate was 5.5% (1/18) with 1 postablative acromion fracture., Conclusions: PCA for extraspinal thyroid cancer bone metastases demonstrated high local tumor control rates with a safe profile at long-term follow-up., (Copyright © 2022 SIR. Published by Elsevier Inc. All rights reserved.)

Metal artifact reduction (MAR) algorithms are used with cone beam computed tomography (CBCT) during augmented reality surgical navigation for minimally invasive pedicle screw instrumentation. The aim of this study was to assess intra- and inter-observer reliability of pedicle screw placement and to compare the perception of baseline image quality (NoMAR) with optimized image quality (MAR). CBCT images of 24 patients operated on for degenerative spondylolisthesis using minimally invasive lumbar fusion were analyzed retrospectively. Images were treated using NoMAR and MAR by an engineer, thus creating 48 randomized files, which were then independently analyzed by 3 spine surgeons and 3 radiologists. The Gertzbein and Robins classification was used for screw accuracy rating, and an image quality scale rated the clarity of pedicle screw and bony landmark depiction. Intra-class correlation coefficients (ICC) were calculated. NoMAR and MAR led to similarly good intra-observer (ICC > 0.6) and excellent inter-observer (ICC > 0.8) assessment reliability of pedicle screw placement accuracy. The image quality scale showed more variability in individual image perception between spine surgeons and radiologists (ICC range 0.51−0.91). This study indicates that intraoperative screw positioning can be reliably assessed on CBCT for augmented reality surgical navigation when using optimized image quality. Subjective image quality was rated slightly superior for MAR compared to NoMAR.

Objectives: To report on safety and clinical effectiveness of cryoablation for the treatment of spinal metastases (SM) in patients needing pain palliation or local tumor control (LTC)., Methods: All consecutive patients with SM who underwent cryoablation from May 2008 to September 2020 in two academic centers were retrospectively identified and included in the present analysis. Patient characteristics, goal of treatment (curative/palliative), SM characteristics, procedural details, and clinical outcomes (pain relief; local tumor control [LTC]) were analyzed., Results: There were 74 patients (35 women; median age 61 years) accounting for 105 SM. Additional cementoplasty was used for 76 SM (76/105; 72.4%). There were 9 complications (out of 105 SM [8.5%]; 2 major and 7 minor) in 8 patients. Among the 64 (64/74; 86.5%) patients with painful SM, the mean Numerical Pain Rating Scale dropped from 6.8 ± 2.2 (range, 0-10) at the baseline to 4.1 ± 2.4 (range, 0-9; p < 0.0001) at 24 h, 2.5 ± 2.6 (range, 0-9; p < 0.0001) at 1 month, and 2.4 ± 2.5 (range, 0-9; p < 0.0001) at the last available follow-up (mean 14.7 ± 19.6 months; median 6). Thirty-four patients (34/64; 53.1%) were completely pain-free at the last follow-up. At mean 25.9 ± 21.2 months (median 16.5) of follow-up, LTC was achieved in 23/28 (82.1%) SM in 21 patients undergoing cryoablation with curative intent., Conclusion: Cryoablation of SM, often performed in combination with vertebral augmentation, is safe, achieves fast and sustained pain relief, and provides high rates of LTC at mean 2-year follow-up., Key Points: •Cryoablation of spinal metastases is safe. •Cryoablation of spinal metastases allows rapid and sustained pain relief. •The mean 2-year rate of local tumor control after cryoablation of spinal metastases is 82.1%., (© 2022. The Author(s), under exclusive licence to European Society of Radiology.)

Purpose: To report techniques and results of 16 cryoablation procedures in 11 patients treated for recurrent head and neck cancer., Methods and Materials: This retrospective study reviewed 11 consecutive patients with head and neck cancer recurrence after primary treatment by surgery and radiotherapy, treated with cryoablation between 2016 and 2020. Efficacy was measured by local control rate evaluated on MRI or/and PET. Tumor characteristics, number of cryoprobes, thermoprotective measures and complications were documented., Results: Sixteen cryoablation procedures were performed in 11 patients with head and neck cancer recurrence after surgery or radiotherapy, deemed ineligible for classic salvage treatment. Among 11 patients, four were treated for an epidermoid carcinoma, four for an adenocarcinoma and three for other types: 1 muco-epidermoid carcinoma, 1 adenoid cystic carcinoma and 1 esthesioneuroblastoma, 10/11 patients had prior surgery, 7/11 patients had prior chemotherapy and 3/11 patients had prior radiotherapy. Median number of cryoprobes was 4, [IQR, 3-6 cryoprobes], thermoprotective measures to protect surrounding organs were required for 10/16 procedures. After cryoablation, local control rate was 45.4% at a mean follow-up of 11.7 months (range 3-34 months). Among the 16 cryoablation procedures, four resulted in complications, two were considered major complications: one septic shock on inhalation pneumopathy during extubation, requiring intensive care; and one dysphonia due to a recurrent nerve injury., Conclusion: Cryoablation as a salvage treatment for recurrence of head and neck tumors after surgery and/or radiotherapy is an effective option, especially for patients that cannot benefit from salvage surgery., (© 2022. Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE).)

Purpose: To retrospectively investigate the safety and oncological outcomes of cryoablation performed on residual/recurring renal cell carcinoma (RCC) in the ipsilateral kidney following partial nephrectomy (PN)., Materials and Methods: Data dealing with patients', RCC, procedure (including the length of the hospital stay), and follow-up (technical efficacy [TE], local tumor progression-free survival [LTPFS], disease-free survival [DFS], metastasis-free survival [MFS], cancer-specific survival (CSS), and overall survival [OS]) were retrospectively collected and analyzed., Results: Between January 2008 and November 2020, 21 consecutive patients (17 [81%] men; 4 [19%] women; median age 68 years; range 43-82) underwent cryoablation due to residual/recurring RCC in the PN site (15 patients) or de-novo RCC (6 patients) in the ipsilateral kidney. Median tumor size was 2.2 cm (mean 2.3 cm; range 0.8-4; interquartile range [IQR] 1.9-3). There were two (2/21; 10%) minor self-limiting hemorrhagic complications, both occurring in the group of patients with RCC in the PN site. Median hospital stay was 2 days (mean 2.1; range 1-5; IQR 2-2). TE was 100% (21/21 patients), and 10-year estimates of LTPFS, MFS and DFS were 74.1% (95% confidence intervals [CI] 56.8-96.7%), 36.4% (95% CI 14.2-93.8%), and 43.5% (95% CI 21.9-86.4%), respectively. CSS and OS were 100% at the last available follow-up (median 56 months; mean 67.4; range: 12-147; IQR:34-95)., Conclusion: Cryoablation in patients with residual/recurring RCC following PN is safe and results in high 10-year estimates of LTPFS., (© 2022. Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE).)

Desmoid tumours (DT) are rare locally infiltrative soft-tissue tumours which do not metastasise. DT arise sporadically or are associated with familial syndromes, with different clinical and genetic patterns. In recent years there has been an increasing therapeutic role of cryoablation for the treatment of sporadic DT. Therefore, in this present review, we: (a) summarize all the main epidemiological, clinical, and therapeutic aspects of sporadic DT that are relevant to an interventional radiologists' practice; (b) present the results of a systematic review that has been conducted with the intent of highlighting the main clinical outcomes available thus far with cryoablation; and (c) discuss the current and future potential applications of cryoablation in this field. Five studies were included in the systematic review accounting for 146 patients. Only 18.5% patients received cryoablation as a first-line treatment. Overall, the volume of the DT undergoing cryoablation was very large (mean total DT volume of 237 cm 3 ). Major complications were noted for 13.3-30% patients and following 2.4-6.7% interventional sessions. The rates of complete tumour response ranged between 0 and 43.3%. 1- and 3-year local progression-free survival rates were 85.1-85.8%, and 77.3-82.9%, respectively. Complete pain relief was reported in 40-66.7% symptomatic patients. In conclusion, cryoablation is currently proposed as a therapeutic strategy to very large DT, which is recognized to be associated with an increased procedure-related morbidity and reduced rates of complete tumour response. Proposing cryoablation as the first-line treatment may improve these clinical outcomes., (© 2022. Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE).)

Osteoplasty is a minimally invasive imaging-guided intervention providing mechanical stabilization, bone consolidation and pain relief in oncologic patients presenting with non-osteoblastic bone metastases or with insufficiency fractures. The intervention relies on the injection of an acrylic substance (ie, polymethylmethacrylate; PMMA) into the target bone. PMMA is very resistant to axial compressive loads but much less to bending, torsional and shearing stresses. Accordingly, from a biomechanical standpoint osteoplasty is adapted for the palliative treatment of small painful lytic bone defects located in the epiphyseal region of long bones in patients with clear surgical contraindications; or for increasing the anchoring of the osteosynthesis material into the target bone. Although pain relief is rapid and effective following osteoplasty, secondary fractures have been reported in up to 8-9% of long bone tumors undergoing such intervention; and following such event, fixation with endomedullary osteosynthetic material (eg, nailing) is not practicable any more. Accordingly, careful patients' selection is critical and should happen with a multidisciplinary approach., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Neuroendocrine neoplasms (NENs) are rare and heterogeneous epithelial tumors most commonly arising from the gastroenteropancreatic (GEP) system. GEP-NENs account for approximately 60% of all NENs, and the small intestine and pancreas represent two most common sites of primary tumor development. Approximately 80% of metastatic patients have secondary liver lesions, and in approximately 50% of patients, the liver is the only metastatic site. The therapeutic strategy depends on the degree of hepatic metastatic invasion, ranging from liver surgery or percutaneous ablation to palliative treatments to reduce both tumor volume and secretion. In patients with grade 1 and 2 NENs, locoregional nonsurgical treatments of liver metastases mainly include percutaneous ablation and endovascular treatments, targeting few or multiple hepatic metastases, respectively. In the present work, we provide a narrative review of the current knowledge on liver-directed therapy for metastasis treatment, including both interventional radiology procedures and nuclear medicine options in NEN patients, taking into account the patient clinical context and both the strengths and limitations of each modality.

Objective: To evaluate the safety of the insertion of a blunt-tip thermosensor inside the anterior epidural space using the trans-osseous route in the dorsal spine and the double oblique trans-foraminal approach in the lumbar spine., Materials and Methods: A total of 10 attempts were made on a 91 years old human specimen. Thermosensors were inserted under fluoroscopic guidance in the anterior part of the spinal canal using various oblique angulations. Surgical dissection was then performed to identify the position of the thermosensor and look for any injury to the dural sac or the spinal cord/cauda equina., Results: Nine thermosensors could be deployed successfully in the anterior part of the spinal canal from Th8 to L5 while one attempt (L5 level) failed due to a technical issue on the coaxial needle. On anteroposterior projection, the tip of thermosensor relative to the midline was classified as centered in 5 cases, overcrossing in 3 cases and undercrossing in 1 case. At surgical dissection, the tip of the thermosensor was epidural posterior to the posterior longitudinal ligament in 8 cases and anterior to the longitudinal ligament in 1 case (the undercrossing case). There were 3 tears to the dura, all in the overcrossing group. There was no case of injury to the spinal cord/cauda equina., Conclusion: Insertion of a thin blunt-tip thermosensor with optimal angulation leads to an epidural post-ligamentous position on the midline without damage to the dural sac. The blunt-tip did not prevent from dural tearing should the insertion overcross the midline., (© 2021. Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE).)

Objectives: To retrospectively evaluate the safety and technical success of pre-operative embolization (POE) of head and neck paragangliomas (HNP) in a single-center cohort over a 10-year period, and to benchmark our results with those derived from a systematic analysis of the available literature., Methods: All consecutive HNP embolized between November 2010 and April 2020 were included and reviewed. In total, there were 27 HNP in 27 patients [8 (30%) males; 19 (70%) females; mean age 53 ± 16 years; range 30-86]. Embolization technique, total procedure time, dose area product (DAP), complications, rate of HNP devascularization, and technical success (i.e. ≥80% devascularization of the HNP) were recorded and analyzed. A systematic analysis on the safety and technical success of POE was then conducted according to the Systematic Reviews and Meta-Analyses (PRISMA) guidelines., Results: Twenty-one (21/27; 78%) HNP were treated with an endovascular approach and 6/27 (22%) with a percutaneous or combined (endovascular/percutaneous) technique. Mean total procedure time and DAP were 108 ± 48 min (range 45-235) and 92.5 ± 61.3 Gy·cm 2 (range 19.9-276.0), respectively. Two (2/27; 7%) complications (one minor, one major) were observed. Mean HNP devascularization was 88 ± 15% (range 23-100) with technical success achieved in 24/27 (89%) HNP. Literature analysis revealed a pooled rate of complication and technical success of 3.8% (95% CI: 0.5-8.8%) and 79.0% (95% CI: 63.6-91.6%), respectively., Conclusions: POE of HNP is safe and results in extensive devascularization in the majority of treated tumors., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objectives: To investigate the 12-month all-cause mortality and morbidity in patients with osteoporotic vertebral compression fractures (OVCFs) undergoing vertebroplasty/balloon kyphoplasty (VP/BKP) versus non-surgical management (NSM)., Methods: Following a Medline and EMBASE search for English language articles published from 2010 to 2019, 19 studies reporting on mortality and morbidity after VP/BKP in patients with OVCFs were selected. The 12-month timeline was set due to the largest amount of data availability at such time interval. Estimates for each study were reported as odds ratios (OR) along with 95% confidence intervals (CI) and p values. Fixed or random-effects meta-analyses were performed. All tests were based on a two-sided significance level of 0.05., Results: Pooled OR across 5 studies favored VP/BKP over NSM in terms of 12-month all-cause mortality (OR: 0.81 [95% CI: 0.46-1.42]; p = .46). Pooled OR across 11 studies favored VP/BKP over NSM in terms of 12-month all-cause morbidity (OR: 0.64 [95% CI: 0.31-1.30]; p = .25). Sub-analysis of data dealing with 12-month infective morbidity from any origin confirmed the benefit of VP/BKP over NSM (OR: 0.23 [95% CI, 0.02-2.54]; p = .23)., Conclusion: Compared to NSM, VP/BKP reduces the 12-month risk of all-cause mortality and morbidity by 19% and 36%, respectively. Moreover, VP/BKP reduces by 77% the 12-month risk of infection from any origin., Key Points: • Compared to non-surgical management, vertebral augmentation reduces the 12-month risk of all-cause mortality by 19% and all-cause morbidity by 36%. • Vertebral augmentation reduces the 12-month risk of infection morbidity from any origin by 77%., (© 2021. European Society of Radiology.)

Purpose: To retrospectively assess the technical feasibility, safety, and oncologic outcomes of percutaneous image-guided cryoablation (PCA) of locoregional and distant lymph node metastases (LNMs)., Methods: All consecutive patients undergoing PCA of LNMs between February 2009 and December 2019 were identified using a retrospective database search. Every patient was followed up at 1, 3, 6, and 12 months after treatment using contrast-enhanced magnetic resonance imaging and at approximately 3-6-month intervals using computed tomography or positron emission tomography-computed tomography. The Kaplan-Meier method was used to calculate local tumor progression-free survival, disease-free survival, and overall survival. Locoregional and distant groups were compared using the Fisher test. Technical success, technique efficacy, complications, and oncologic outcomes were analyzed., Results: Fifty-six metachronous oligometastatic LNMs (median size, 15 mm [interquartile range, 13-15 mm; range, 9-36 mm]) were treated in 37 sessions in 29 patients and defined as locoregional (26/37 sessions) or distant (11/37 sessions). Seventeen patients had undergone prior surgery or radiotherapy. Six patients underwent 8 retreatments for locoregional progression. An additional visceral oligometastasis was treated in 4 of the 11 distant LNM PCA sessions. The technical success and primary technique efficacy rates were 100%. The complication rate was 5.4% (2 transient nerve palsies). At a median follow-up of 23 months, there were 2 instances of local tumor progression (5.6%); the 1-, 2-, and 3-year local tumor progression-free survival was 100%, 94.3%, and 94.3%, respectively. Thirteen (45%) patients demonstrated no disease progression. The 1-, 2-, and 3-year overall survival was 96.2%, 90.5%, and 70%, respectively. The patients were free from systemic oncologic therapy following 20 (54%) sessions, with a mean treatment break of 19.1 months., Conclusions: The PCA of lymph node oligometastases is feasible and safe, and offers promising local tumor control at midterm follow-up., (Copyright © 2021 SIR. Published by Elsevier Inc. All rights reserved.)

Aim: To assess pain relief and local tumour control retrospectively in spinal metastases undergoing cryoablation., Materials and Methods: Between May 2008 and September 2020, 46 metastases in 41 consecutive patients (mean age 59.7±4.4 [SD] years; range 27-84) were treated with cryoablation in 42 interventional sessions. Patient demographics, procedural data, complications, pain, and local tumour control were analysed retrospectively., Results: Thirty-one patients (36 spine metastases; 32 sessions) were treated for pain relief and 10 (10 metastases; 10 sessions) for local tumour control. Clinical success was reached in 30/32 (93.8%) interventional palliative sessions. Mean pre-procedural numerical pain rate scale was 6.2±1.7 (SD), and dropped significantly to 3.5±1.8 (SD), 1.9±1.7 (SD), and 1.9±1.8 (SD) at 24-h, 1-month and at the last available follow-up (median 16.5±23.2 [SD] months), respectively. For patients requiring local tumour control, primary clinical success was reached in 6/10 (60%) spinal metastases at median 25-months follow-up. The overall complication rate was 8%, with no secondary fractures or iatrogenic thermal-mediated nerve injuries reported., Conclusion: Percutaneous image-guided cryoablation of spinal metastases is safe and effective in achieving pain relief and local tumour control., (Copyright © 2021 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.)

Purpose: The purpose of this study was to evaluate the safety and oncologic efficacy of percutaneous magnetic resonance imaging (MRI)-guided cryoablation of intraparenchymal renal cancer., Materials and Methods: Between February 2009 and August 2019, 31 consecutives patients with 31 entirely intraparenchymal biopsy-proven renal cancers were treated with cryoablation under MRI-guidance in our institution, and were retrospectively included. There were 20 men and 11 women with a mean age of 68.5±12.5 (SD) (range: 40-91years). Patient, tumor- and procedure-related, and follow-up data were retrospectively collected and analyzed. Local recurrence free (LRFS), metastasis free (MFS), disease free (DFS), cancer specific (CSS), and overall survivals (OS) were calculated., Results: Primary and secondary technical efficacy rates were 94% and 100%, respectively. Median follow-up was 27months. Seven (7/31; 23%) minor complications were noted in 7 patients. Patients showed a significant decline of the estimated glomerular filtration rate (eGFR) between baseline and nadir (mean basal eGFR 65.9±22.4 [SD] mL/min/1.73m 2 vs. mean nadir eGFR 52.8±26.0 [SD] mL/min/1.73m 2 ; P<0.001), but only two showed a clinically significant renal function decline. Three-year estimates of primary and secondary LRFS, MFS, and DFS were 64% (95% confidence interval [CI]: 47-87%), 89% (95% CI: 78-99%), 83% (95% CI: 77-98%), and 45% (95% CI: 28-73%), respectively. No patients died due to renal cancer evolution (three-year CSS of 100%; 95% CI: 100-100%). One patient died 52months after the percutaneous treatment due to cryoablation-unrelated causes (three-year OS of 100%; 95% CI: 100-100%)., Conclusion: MRI-guided percutaneous cryoablation for intraparenchymal renal cancer offers good oncologic outcomes with acceptable complication rates and renal function worsening., (Copyright © 2021 Société française de radiologie. Published by Elsevier Masson SAS. All rights reserved.)

Purpose: To describe the guidewire technique to perform hydrodistension and create artificial ascites during liver microwave ablation (MWA) of tumors located in the hepatic dome and evaluate the effectiveness of repartition of peritoneal fluid along segments VII and VIII with this technique., Materials and Methods: A retrospective review of all 18 consecutive patients who benefited from MWA combined with hydrodistension causing artificial ascites performed with the guidewire technique was conducted. The technique involves inserting a 20G spinal needle in the liver parenchyma and catheterizing the peritoneum with a 0.018 nitinol guidewire while retrieving the needle from the liver. Technical success was defined by the successful insertion of a sheath over the wire in the peritoneal cavity and identification of peritoneal fluid on CT images, with repartition of ascites around segments VII and VIII., Results: Target tumors were located in segments VII and VIII and had a mean size of 27.7 mm with a mean distance from the diaphragm of 1.7 mm. Technical success of artificial ascites was 14/18 (78%). In the four cases where artificial ascites failed, patients had undergone previous liver surgery. In the 14 cases for which artificial ascites were successful, complete separation of the diaphragm from the ablation zone was noted in 9/14 cases and partial separation in 5/14 cases., Conclusion: Hydrodistension with the guidewire technique is effective and safe to accomplish artificial ascites. The extent of repartition of peritoneal fluid is variable, especially in the peritoneal recess in contact with the bare area where diffusion of fluid was variable., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Study Design: This was a retrospective observational study., Objective: The aim of this study was to evaluate the accuracy of percutaneous pedicle screw placement using augmented reality surgical navigation during minimally invasive transforaminal lumbar interbody fusion (TLIF)., Summary of Background Data: Augmented reality-based navigation is a new type of computer-assisted navigation where video cameras are used instead of infrared cameras to track the operated patients and surgical instruments. This technology has not so far been clinically evaluated for percutaneous pedicle screw placement., Materials and Methods: The study assessed percutaneous pedicle screw placement in 20 consecutive patients who underwent single-level minimally invasive TLIF using augmented reality surgical navigation. Facet joint violation and depression by the inserted pedicle screws were evaluated. Secondary outcome such as radiation dose exposure, fluoroscopy time, and operative time were collected for 3 phases of surgery: preparation phase, pedicle screw placement, and decompression with cage placement., Results: A clinical accuracy for screw placement within the pedicle (Gertzbein 0 or 1) of 94% was achieved. One screw violated the facet joint with a transarticular pathway. The screw head did not depress the facet in 54%. The use of fluoroscopy during navigation correlated with patient body-mass index (r=0.68, P<0.0001). The pedicle screw placement time corresponded to 36±5% of the total operative time of 117±11 minutes. A statistically significant decrease of 10 minutes in operative time was observed between the first and last 10 procedures which corresponded to the pedicle screw placement time decrease (48±9 vs. 38±7 min, P=0.0142). The learning curve model suggests an ultimate operative time decrease to 97 minutes., Conclusion: Augmented reality surgical navigation can be clinically used to place percutaneous screws during minimally invasive TLIF. However, the lack of tracking of the location of the device requires intraoperative fluoroscopy to monitor screw insertion depth especially in obese patients., Level of Evidence: Level III., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)