Impact of Percutaneous Cryoablation on Renal Function in Patients with Stage I Renal Cell Carcinoma: A Systematic Review and Meta-Analysis.

PURPOSE: To assess the effect of cryoablation on renal function (measured by eGFR or serum creatinine) for treating Stage I renal cancer. MATERIALS AND METHODS: MEDLINE, EMBASE, and the CENTRAL databases were systematically searched from inception to May 1, 2023. Cohort studies that included data on change of estimated glomerular filtration rate (eGFR) and serum creatinine increase were included. Meta-analysis was performed by measuring the weighted mean difference and by fitting random-effect models. RESULTS: Overall, 38 studies were included, comprising of 3,202 participants. Percutaneous cryoablation was associated with an absolute eGFFR reduction of -3.06 ml/min/1.73 m2 (95% CI: -4.12 to -2.01; p-value < 0.001) and serum creatinine increase of 0.05 mg/dl (95% CI: -0.02 to 0.11; p-value> 0.05). The weighted absolute mean difference of percutaneous cryoablation for treating stage T1b renal cell carcinoma was estimated at -5.19 ml/min/1.73 m2 (95% CI: -11.1 to 0.72; p-value > 0.05). Lastly, when analyzing studies that included cohorts with solitary kidneys, the pooled weighted mean difference was estimated as -3.27 ml/min/1.73 m2 (95% CI: -6.79 to 0.25; pvalue >0.05). CONCLUSIONS: Percutaneous cryoablation for Stage 1 renal cell carcinoma has minimal significant impact on renal function (measured by eGFR or serum creatinine). The same outcome was observed in patients with larger tumors (T1b) and those with solitary kidneys.

Artificial intelligence in hepatocellular carcinoma diagnosis: a comprehensive review of current literature.

BACKGROUND AND AIM: Hepatocellular carcinoma (HCC) diagnosis mainly relies on its pathognomonic radiological profile, obviating the need for biopsy. The project of incorporating artificial intelligence (AI) techniques in HCC aims to improve the performance of image recognition. Herein, we thoroughly analyze and evaluate proposed AI models in the field of HCC diagnosis. METHODS: A comprehensive review of the literature was performed utilizing MEDLINE/PubMed and Web of Science databases with the end of search date being the 30th of September 2023. The MESH terms "Artificial Intelligence," "Liver Cancer," "Hepatocellular Carcinoma," "Machine Learning," and "Deep Learning" were searched in the title and/or abstract. All references of the obtained articles were also evaluated for any additional information. RESULTS: Our search resulted in 183 studies meeting our inclusion criteria. Across all diagnostic modalities, reported area under the curve (AUC) of most developed models surpassed 0.900. A B-mode US and a contrast-enhanced US model achieved AUCs of 0.947 and 0.957, respectively. Regarding the more challenging task of HCC diagnosis, a 2021 deep learning model, trained with CT scans, classified hepatic malignant lesions with an AUC of 0.986. Finally, a MRI machine learning model developed in 2021 displayed an AUC of 0.975 when differentiating small HCCs from benign lesions, while another MRI-based model achieved HCC diagnosis with an AUC of 0.970. CONCLUSIONS: AI tools may lead to significant improvement in diagnostic management of HCC. Many models fared better or comparable to experienced radiologists while proving capable of elevating radiologists' accuracy, demonstrating promising results for AI implementation in HCC-related diagnostic tasks.

Magnetic resonance-guided focused ultrasound versus percutaneous thermal ablation in local control of bone oligometastases: a systematic review and meta-analysis.

BACKGROUND: The percutaneous thermal ablation techniques (pTA) are radiofrequency ablation, cryoablation, and microwave ablation, suitable for the treatment of bone oligometastases. Magnetic resonance-guided focused ultrasound (MRgFUS) is a noninvasive ablation technique. OBJECTIVES: To compare the effectiveness and safety of MRgFUS and pTA for treating bone oligometastases and their complications. METHODS: Studies were selected with a PICO/PRISMA protocol: pTA or MRgFUS in patients with bone oligometastases; non-exclusive curative treatment. Exclusion criteria were: primary bone tumor; concurrent radiation therapy; palliative therapy; and absence of imaging at follow-up. PubMed, BioMed Central, and Scopus were searched. The modified Newcastle-Ottawa Scale assessed articles quality. For each treatment (pTA and MRgFUS), we conducted two separate random-effects meta-analyses to estimate the pooled effectiveness and safety. The effectiveness was assessed by combining the proportions of treated lesions achieving local tumor control (LTC); the safety by combining the complications rates of treated patients. Meta-regression analyses were performed to identify any outcome predictor. RESULTS: A total of 24 articles were included. Pooled LTC rate for MRgFUS was 84% (N = 7, 95% CI 66-97%, I2 = 74.7%) compared to 65% of pTA (N = 17, 95% CI 51-78%, I2 = 89.3%). Pooled complications rate was similar, respectively, 13% (95% CI 1-32%, I2 = 81.0%) for MRgFUS and 12% (95% CI 8-18%, I2 = 39.9%) for pTA, but major complications were recorded with pTA only. The meta-regression analyses, including technique type, study design, tumor, and follow-up, found no significant predictors. DISCUSSION: The effectiveness and safety of the two techniques were found comparable, even though MRgFUS is a noninvasive treatment that did not cause any major complication. Limited data availability on MRgFUS and the lack of direct comparisons with pTA may affect these findings. CONCLUSIONS: MRgFUS can be a valid, safe, and noninvasive treatment for bone oligometastases. Direct comparison studies are needed to confirm its promising benefits.

Computed tomography-guided percutaneous microwave ablation for renal cell carcinoma: evaluating the performance of nephrometry scores.

OBJECTIVES: The purpose of the current study is to evaluate the performance of RENAL and mRENAL scores, in the prediction of oncological outcomes in patients treated with microwave ablation (MWA) for (T1) renal cell carcinomas (RCC). METHODS: Institutional database retrospective research identified 76 patients with a biopsy-proven solitary T1a (84%) or T1b (16%) RCC; all patients underwent CT-guided MWA ablation. Tumor complexity was reviewed by calculating RENAL and mRENAL scores. RESULTS: The majority of the lesions were exophytic (82.9%), with > 7 mm nearness to the collecting system (53.9%), located posteriorly (73.6%), and lower to polar lines (61.8%). Mean RENAL and mRENAL scores were 5.7 (SD = 1.9) and 6.1 (SD = 2.1) respectively. Progression rates were significantly higher with greater tumor size (> 4 cm), with < 4 mm nearness to the collecting system, for tumors crossing a polar line and with the anterior location. None of the above was associated with complications. RENAL and mRENAL scores were significantly higher in patients with incomplete ablation. The ROC analysis showed the significant prognostic ability of both RENAL and mRENAL scores for progression. In both scores, the optimal cut-off point was 6.5. Univariate Cox regression analysis for progression showed a hazard ratio of 7.73 for the RENAL score and 7.48 for the mRENAL score. CONCLUSION: The results of the present study show that the risk of progression was higher in patients with RENAL and mRENAL score of > 6.5, in T1b tumors, close to the collective system (< 4 mm), crossing polar lines and anterior location. CLINICAL RELEVANCE STATEMENT: CT-guided percutaneous MWA is a safe and effective technique for the treatment of T1a renal cell carcinomas. Different morphometric parameters of RCC tumors including RENAL and mRENAL score > 6.5, size, proximity to the collecting system, and crossing of polar lines impact the efficacy of MWA and progression survival rates. KEY POINTS: • The risk of progression is higher in patients with RENAL and mRENAL score > 6.5, in T1b tumors, close to the collective system (< 4 mm), crossing polar lines and anterior location. • The significant prognostic ability of the mRENAL score for progression was higher than the respective of the RENAL score. • Complications were not associated with any of the above factors.

Musculoskeletal Interventional Oncology: A Contemporary Review.

Musculoskeletal interventional oncology is an emerging field that addresses the limitations of conventional therapies for bone and soft-tissue tumors. The field's growth has been driven by evolving treatment paradigms, expanding society guidelines, mounting supportive literature, technologic advances, and cross-specialty collaboration with medical, surgical, and radiation oncology. Safe, effective, and durable pain palliation, local control, and stabilization of musculoskeletal tumors are increasingly achieved through an expanding array of contemporary minimally invasive percutaneous image-guided treatments, including ablation, osteoplasty, vertebral augmentation (with or without mechanical reinforcement via implants), osseous consolidation via percutaneous screw fixation (with or without osteoplasty), tumor embolization, and neurolysis. These interventions may be used for curative or palliative indications and can be readily combined with systemic therapies. Therapeutic approaches include the combination of different interventional oncology techniques as well as the sequential application of such techniques with other local treatments, including surgery or radiation. This article reviews the current practice of interventional oncology treatments for the management of patients with bone and soft-tissue tumors with a focus on emerging technologies and techniques.

Musculoskeletal oncology and thermal ablation: the current and emerging role of interventional radiology.

The role of interventional radiology (IR) is expanding. With new techniques being developed and tested, this radiology subspecialty is taking a step forward in different clinical scenarios, especially in oncology. Musculoskeletal tumoral diseases would definitely benefit from a low-invasive approach that could reduce mortality and morbidity in particular. Thermal ablation through IR has already become important in the palliation and consolidation of bone metastases, oligometastatic disease, local recurrences, and treating specific benign tumors, with a more tailored approach, considering the characteristics of every patient. As image-guided ablation techniques lower their invasiveness and increase their efficacy while the collateral effects and complications decrease, they become more relevant and need to be considered in patient care pathways and clinical management, to improve outcomes. We present a literature review of the different percutaneous and non-invasive image-guided thermal ablation methods that are currently available and that could in the future become relevant to manage musculoskeletal oncologic diseases.

Role of Percutaneous Ablation in the Management of Intrahepatic Cholangiocarcinoma.

Cholangiocarcinoma (CCA) is an invasive cancer accounting for <1% of all cancers and 10-15% of primary liver cancers. Intrahepatic CCA (iCCA) is associated with poor survival rates and high post-surgical recurrence rates whilst most diagnosed patients are not surgical candidates. There is a growing literature suggesting percutaneous ablative techniques for the management of patients with iCCA measuring ≤3 cm with contraindications to surgery as well as for recurrent or residual tumors aiming to provide local cancer treatment and control. Most used ablative therapies for iCCA include radiofrequency and microwave ablation with irreversible electroporation, cryoablation and reversible electroporation (electrochemotherapy) being less commonly encountered techniques. Due to the infiltrative margins of the lesion, there is a need for larger safety margins and ablation zone; multi-apparatus ablation or other variations of the technique such as balloon-assisted approaches can be utilized aiming to increase size of the zone of necrosis. The present review paper focuses upon the current role of percutaneous ablative techniques for the therapeutic management of iCCA. The purpose of this review is to present the current minimally invasive ablative techniques in the treatment of iCCA, including local control and survival rates.

Ablative Techniques for Sarcoma Metastatic Disease: Current Role and Clinical Applications.

Sarcomas are heterogenous mesenchymal neoplasms with more than 80 different histologic subtypes. Lung followed by liver and bone are the most common sites of sarcoma metastatic disease. Ablative techniques have been recently added as an additional alternative curative or palliative therapeutic tool in sarcoma metastatic disease. When compared to surgery, ablative techniques are less invasive therapies which can be performed even in non-surgical candidates and are related to decreased recovery time as well as preservation of the treated organ's long-term function. Literature data upon ablative techniques for sarcoma metastatic disease are quite heterogeneous and variable regarding the size and the number of the treated lesions and the different histologic subtypes of the original soft tissue or bone sarcoma. The present study focuses upon the current role of minimal invasive thermal ablative techniques for the management of metastatic sarcoma disease. The purpose of this review is to present the current minimally invasive ablative techniques in the treatment of metastatic soft tissue and bone sarcoma, including local control and survival rates.

VOLume flow assistance for optimizing outcomes of dysfunctional autologous arteriovenous fistula Angioplasty: the VOLA Pilot Study.

OBJECTIVES: To investigate the feasibility of VF-assisted angioplasty (VFA) in dysfunctional AVF using sequential intraprocedural duplex ultrasound (DUS), to utilize intraprocedural VF as a quantifiable, functional endpoint in endovascular treatment. METHODS: This prospective study included 20 consecutive patients (23 lesions; 16 men; mean age 67 ± 16 years) with dysfunctional AVF undergoing fluoroscopically guided balloon angioplasty between June 2019 and May 2020. Primary endpoints were quantification of outcome using sequential DUS VF analysis following each dilation, 6-month target lesion re-intervention (TLR)-free rate, standard technical success, procedural success (achievement of a postprocedural VF value equal (or 10% less) or superior to the baseline steady-state access), and correlation between procedural success and TLR-free rate. Secondary endpoints included 6-month lesion late lumen loss (LLL), correlation between balloon diameter used and intraprocedural VF values, and correlation between VF and LLL at 6 months follow-up. RESULTS: Mean VF increase was 168.5% ± 102.5% (range: 24.24-493.33%). Procedural success was 80% (16/20 cases). VFA improved procedural success by 20% (4/20 cases) compared to standard assessment (< 30% residual stenosis and palpable thrill). TLR-free rate was 78.3% and 67.3% at 6 and 12 months. Significantly less TLR was noted in cases of procedural success (82.4% vs. 66.7% 6 months; p = 0.041). Unweighted linear regression showed a significant positive relationship between diameter of balloon and VF (146.9 ± 42.3 mL/min VF gain per mm of balloon diameter; p = 0.001, R2 = 0.23) and a significant negative relationship between LLL and VF decline at follow-up (102.0 ± 34.6 mL/min loss per mm of LLL; p = 0.01, R2 = 0.35). Optimal VF cutoff value and percentile increase to predict access failure were 720 mL/min (sensitivity 58.3%, specificity 71.4%) and 153% (sensitivity 66.7%, specificity 85.7%), respectively. CONCLUSION: Intraprocedural VF assessment could be used to optimize AVF angioplasty. KEY POINTS: • A newly proposed functional endpoint of angioplasty in dysfunctional dialysis fistula was evaluated and angioplasty outcome was quantified using volume flow (VF) assessment with sequential intraprocedural DUS. • Intraprocedural VF assessment improved immediate procedural success; increased balloon diameter was correlated with VF gain and late lumen loss with VF decline. • Intraprocedural VF values ≥ to baseline steady-state values were correlated with less re-interventions.

Clinical indications for image-guided interventional procedures in the musculoskeletal system: a Delphi-based consensus paper from the European Society of Musculoskeletal Radiology (ESSR)-part VII, nerves of the lower limb.

OBJECTIVES: To perform a Delphi-based consensus on published evidence on image-guided interventional procedures for peripheral nerves of the lower limb (excluding Morton's neuroma) and provide clinical indications. METHODS: We report the results of a Delphi-based consensus of 53 experts from the European Society of Musculoskeletal Radiology who reviewed the published literature for evidence on image-guided interventional procedures offered around peripheral nerves in the lower limb (excluding Morton's neuroma) to derive their clinical indications. Experts drafted a list of statements and graded them according to the Oxford Centre for evidence-based medicine levels of evidence. Consensus was considered strong when > 95% of experts agreed with the statement or broad when > 80% but < 95% agreed. The results of the Delphi-based consensus were used to write the paper. RESULTS: Nine statements on image-guided interventional procedures for peripheral nerves of the lower limb have been drafted. All of them received strong consensus. Image-guided pudendal nerve block is safe, effective, and well tolerated with few complications. US-guided perisciatic injection of anesthetic provides good symptom relief in patients with piriformis syndrome; however, the addition of corticosteroids to local anesthetics still has an unclear role. US-guided lateral femoral cutaneous nerve block can be used to provide effective post-operative regional analgesia. CONCLUSION: Despite the promising results reported by published papers on image-guided interventional procedures for peripheral nerves of the lower limb, there is still a lack of evidence on the efficacy of most procedures. KEY POINTS: • Image-guided pudendal nerve block is safe, effective, and well tolerated with few complications. • US-guided perisciatic injection of anesthetic provides good symptom relief in patients with piriformis syndrome; however, the addition of corticosteroids to local anesthetics still has an unclear role. • US-guided lateral femoral cutaneous nerve block can be used to provide effective post-operative regional analgesia. The volume of local anesthetic affects the size of the blocked sensory area.

Clinical indications for image-guided interventional procedures in the musculoskeletal system: a Delphi-based consensus paper from the European Society of Musculoskeletal Radiology (ESSR)-part VI, foot and ankle.

OBJECTIVES: Clarity regarding accuracy and effectiveness for interventional procedures around the foot and ankle is lacking. Consequently, a board of 53 members of the Ultrasound and Interventional Subcommittees of the European Society of Musculoskeletal Radiology (ESSR) reviewed the published literature to evaluate the evidence on image-guided musculoskeletal interventional procedures around this anatomical region. METHODS: We report the results of a Delphi-based consensus of 53 experts from the European Society of Musculoskeletal Radiology who reviewed the published literature for evidence on image-guided interventional procedures offered around foot and ankle in order to derive their clinical indications. Experts drafted a list of statements and graded them according to the Oxford Centre for evidence-based medicine levels of evidence. Consensus was considered strong when > 95% of experts agreed with the statement or broad when > 80% but < 95% agreed. The results of the Delphi-based consensus were used to write the paper that was shared with all panel members for final approval. RESULTS: A list of 16 evidence-based statements on clinical indications for image-guided musculoskeletal interventional procedures in the foot and ankle were drafted after a literature review. The highest level of evidence was reported for four statements, all receiving 100% agreement. CONCLUSION: According to this consensus, image-guided interventions should not be considered a first-level approach for treating Achilles tendinopathy, while ultrasonography guidance is strongly recommended to improve the efficacy of interventional procedures for plantar fasciitis and Morton's neuroma, particularly using platelet-rich plasma and corticosteroids, respectively. KEY POINTS: • The expert panel of the ESSR listed 16 evidence-based statements on clinical indications of image-guided musculoskeletal interventional procedures in the foot and ankle. • Strong consensus was obtained for all statements. • The highest level of evidence was reached by four statements concerning the effectiveness of US-guided injections of corticosteroid for Morton's neuroma and PRP for plantar fasciitis.

Clinical indications for image-guided interventional procedures in the musculoskeletal system: a Delphi-based consensus paper from the European Society of Musculoskeletal Radiology (ESSR)-part V, knee.

OBJECTIVES: Interventional procedures around the knee are widely adopted for treating different musculoskeletal conditions. A panel of experts from the Ultrasound and Interventional Subcommittees of the European Society of Musculoskeletal Radiology (ESSR) reviewed the existing literature to assess the evidence on image-guided musculoskeletal interventional procedures around the knee, with the goal of highlighting some controversies associated with these procedures, specifically the role of imaging guidance, as well as the efficacy of the medications routinely injected. METHODS: We report the results of a Delphi-based consensus of 53 experts in musculoskeletal radiology, who reviewed the published literature for evidence on image-guided interventional procedures around the knee to derive a list of pertinent clinical indications. RESULTS: A list of 10 statements about clinical indications of image-guided procedures around the knee was created by a Delphi-based consensus. Only two of them had the highest level of evidence; all of them received 100% consensus. CONCLUSIONS: Ultrasonography guidance is strongly recommended for intra-articular and patellar tendinopathy procedures to ensure the precision and efficacy of these treatments. Prospective randomized studies remain warranted to better understand the role of imaging guidance and assess some of the medications used for interventional procedures around the knee. KEY POINTS: • A list of 10 evidence-based statements on clinical indications of image-guided interventional procedures around the knee was produced by an expert panel of the ESSR. • Strong consensus with 100% agreement was obtained for all statements. • Two statements reached the highest level of evidence, allowing us to strongly recommend the use of ultrasonography to guide intra-articular and patellar tendon procedures to ensure higher accuracy and efficacy of these treatments.

Clinical indications for image-guided interventional procedures in the musculoskeletal system: a Delphi-based consensus paper from the European Society of Musculoskeletal Radiology (ESSR)-part IV, hip.

OBJECTIVES: Image-guided musculoskeletal interventional procedures around the hip are widely used in daily clinical practice. The need for clarity concerning the actual added value of imaging guidance and types of medications to be offered led the Ultrasound and the Interventional Subcommittees of the European Society of Musculoskeletal Radiology (ESSR) to promote, with the support of its Research Committee, a collaborative project to review the published literature on image-guided musculoskeletal interventional procedures in the lower limb in order to derive a list of clinical indications. METHODS: In this article, we report the results of a Delphi-based consensus of 53 experts who reviewed the published literature for evidence on image-guided interventional procedures offered in the joint and soft tissues around the hip in order of their clinical indications. RESULTS: Ten statements concerning image-guided treatment procedures around the hip have been collected by the panel of ESSR experts. CONCLUSIONS: This work highlighted that there is still low evidence in the existing literature on some of these interventional procedures. Further large prospective randomized trials are essential to better confirm the benefits and objectively clarify the role of imaging to guide musculoskeletal interventional procedures around the hip. KEY POINTS: • Expert consensus produced a list of 10 evidence-based statements on clinical indications of image-guided interventional procedures around the hip. • The highest level of evidence was only reached for one statement. • Strong consensus was obtained for all statements.

Comprehensive Palliative Musculoskeletal Interventional Radiology Care for Patients with Cancer.

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.

Structural and functional brain changes in X-linked Charcot-Marie-Tooth disease: insights from a multimodal neuroimaging study.

PURPOSE: Brain involvement in X-linked Charcot-Marie-Tooth disease (CMTX) has been previously reported. We studied the brain structural and functional integrity using a multimodal neuroimaging approach in patients with no current central nervous system (CNS) symptoms, in order to further delineate the disease's phenotype. METHODS: Seventeen CMTX patients with no current CNS symptoms and 24 matched healthy controls underwent brain magnetic resonance imaging (MRI). Structural integrity was evaluated performing Gray matter analysis with voxel-based morphometry (VBM) and tract-based spatial statistics (TBSS) of diffusion tensor imaging (DTI). Functional integrity was evaluated with resting-state functional MRI (rs-fMRI). RESULTS: Decreased gray matter density was detected in CMTX patients compared to healthy controls in bilateral hippocampus, left thalamus, left postcentral gyrus, left superior parietal lobule, left cerebellum crus I and II, and vermis VI. DTI analysis showed increased fractional anisotropy and radial diffusivity in the right anterior insula and increased axial diffusivity in right cerebellum crus I in CMTX patients. rs-fMRI revealed decreased spontaneous neural activity on left precentral gyrus in patients compared to healthy controls. CONCLUSION: Advanced magnetic resonance (MR) neuroimaging techniques in CMTX patients revealed structural and functional involvement of multiple motor and extra-motor brain areas. MR neuroimaging techniques have the potential to delineate the CNS phenotype of a peripheral neuropathy like CMTX.

Update on Interventional Radiology of the Spine.

Interventional radiologists now perform spinal interventions routinely for diagnostic and therapeutic purposes. New technologies for the management of spine pathologies have emerged with promising results in terms of safety and efficacy. Interventional radiology techniques in the spine include percutaneous biopsy and therapies for intervertebral disk herniation or spinal stenosis, facet and sacroiliac joint pathologies, vertebral and sacral fractures, and metastases. These techniques can also be easily combined one with the other or to further therapeutic approaches including systemic therapies, surgical approaches, and radiotherapy. This review provides a comprehensive overview of current percutaneous imaging-guided interventional radiology techniques in the spine. It will help readers become familiar with the most common indications, learn about different technical considerations during performance, and review the available evidence. Controversies concerning new products and technical approaches are also addressed.

Computed tomography guided radiofrequency ablation of osteoid osteoma in children: a single center's experience.

OBJECTIVE: To report a single center's experience evaluating the efficacy and safety of computed tomography-guided radiofrequency ablation for the treatment of osteoid osteoma in children. MATERIALS AND METHODS: Institutional database research identified 33 symptomatic patients (≤ 18 years of age; male/female ratio: 21/12, mean age 13.09 ± 3.66) with osteoid osteoma who were treated by CT-guided RFA. Technical and clinical success as well as complication rates were recorded. The duration of the procedure, the number of computed tomography scans and the results of the biopsy were assessed. Pain, prior, the following morning and 1 week, 1/6/12 months after the procedure were compared by means of a numeric visual scale (NVS) questionnaire. RESULTS: Mean lesion size was 8.28 ± 4.24 mm. Mean follow-up was 23.33 ± 17.61 months (range 12-62). Mean pain score prior to radiofrequency ablation was 9.06 ± 0.80 NVS units. On week 1 and 1/6/12 months, all patients were pain-free reporting 0 NVS units (p < 0.05). The mean procedure time was 54 min (range 51-59) and a mean of 7 CT scans were performed during the ablation session. RF electrode was successfully placed in the center of the nidus in all cases. In our study, none of our patient experienced recurrence of the pain, nor complications. CONCLUSION: The present study demonstrates that percutaneous CT-guided radiofrequency ablation constitutes a safe and effective technique for osteoid osteoma treatment in children.

Covid Visual Assessment Scale ("Co.V.A.Sc."): quantification of COVID-19 disease extent on admission chest computed tomography (CT) in the prediction of clinical outcome-a retrospective analysis of 273 patients.

BACKGROUND: Admission chest CT is often included in COVID-19 patient management. PURPOSE: To evaluate the inter- and intraobserver variability of the Covid Visual Assessment Scale ("Co.V.A.Sc.") used for stratifying chest CT disease extent and to estimate its prospect to predict clinical outcomes. MATERIALS AND METHODS: This single-center, retrospective observational cohort study included all RT-PCR-confirmed COVID-19 adult patients undergoing admission chest CT, between 01/03/2021 and 17/03/2021. CTs were independently evaluated by two radiologists according to the "Co.V.A.Sc." (0: 0%, 1: 1-10%, 2: 11-25%, 3: 26-50%, 4: 51-75%, 5: > 75%). Patient demographics, laboratory, clinical, and hospitalization data were retrieved and analyzed in relation to the "Co.V.A.Sc." RESULTS: Overall, 273 patients (mean age 60.7 ± 14.8 years; 50.9% male) were evaluated. Excellent inter- and intraobserver variability was noted between the two independent radiologists' "Co.V.A.Sc." EVALUATIONS: "Co.V.A.Sc." classification (Exp(B) 0.391, 95%CI 0.212-0.719; p = 0.025) and patient age (Exp(B) 0.947, 95%CI 0.902-0.993; p = 0.25) were the only variables correlated with ICU admission, while age (Exp(B) 1.111, p = 0.0001), "Co.V.A.Sc." (Exp(B) 2.408; p = 0.002), and male gender (Exp(B) 3.213; p = 0.028) were correlated with in-hospital mortality. Specifically, for each "Co.V.A.Sc." unit increase, the probability of ICU admission increased by 1.47 times, and the probability of death increased by 11.1 times. According to ROC analysis, "Co.V.A.Sc." could predict ICU admission and in-hospital death with an optimal cutoff value of unit 3 (sensitivity 56.0%, specificity 84.3%) and unit 4 (sensitivity 41.9%, specificity 93.6%), respectively. CONCLUSION: "Co.V.A.Sc." upon hospital admittance seems to predict ICU admission and in-hospital death and could aid in optimizing risk-stratification and patient management.

Navigation Guidance for Percutaneous Splanchnic Nerve Radiofrequency Neurolysis: Preliminary Results.

Background and Objectives: To describe preliminary results upon the application of the "Cube Navigation System" (CNS) for computed tomography (CT)-guided splanchnic nerve radiofrequency neurolysis. Materials and Methods: CT-guided splanchnic nerve neurolysis was performed in five patients; in all cases, neurolysis was performed under CT guidance using the CNS. The mean patient age was 71.6 years (range 54-81 years; male/female: 5/0). Technical success, parameters of the neurolysis session and complications were evaluated. Technical success was defined as a needle position on the defined target. Session parameters included procedure time and number of scans. The CIRSE reporting system was used for complications' classification and grading. Results: Technical success was obtained in all cases; in 1/5 patients, a slight correction in needle orientation was necessary. Mean procedure time was 12.4 min (range 8-19 min); an average of four CT scans was recorded in the five neurolysis sessions. There were no complications or material failures reported in the present study. Conclusions: Preliminary results of the present study show that computed tomography (CT)-guided splanchnic nerve radiofrequency neurolysis using the CNS is an accurate and time-efficient percutaneous procedure. More prospective and comparative studies with larger patient samples are necessary for verification of this system as well as for drawing broader conclusions.

Vertebral Augmentation: Is It Time to Get Past the Pain? A Consensus Statement from the Sardinia Spine and Stroke Congress.

Vertebral augmentation has been used to treat painful vertebral compression fractures and metastatic lesions in millions of patients around the world. An international group of subject matter experts have considered the evidence, including but not limited to mortality. These considerations led them to ask whether it is appropriate to allow the subjective measure of pain to so dominate the clinical decision of whether to proceed with augmentation. The discussions that ensued are related below.