Purpose:To evaluate the safety and efficacy of middle meningeal artery embolization (MMAE) using small polyvinyl alcohol (PVA) particles (45-150 µm) with or without coils for chronic subdural hematoma (cSDH) and to assess peri-interventional imaging predictors and survival outcomes. Materials and Methods:This retrospective single-center observational study included patients (≥18 years) undergoing MMAE for cSDH between June 2019 and March 2024 at a tertiary neurovascular center. Inclusion criteria required pre-, post-interventional imaging and clinical follow-up; exclusions were acute traumatic hematomas, embolization with liquid embolics or coils alone, and insufficient imaging quality. Embolization was performed using PVA particles between 45-150 µm in size with or without coils. Primary endpoint: need for retreatment. Secondary endpoints: radiological hematoma evolution, modified Rankin Scale (mRS) score, procedure-related complications, and mortality. Statistical analysis included Cochran's Q test, Friedman ANOVA, χ² tests, Fisher's exact and Mann-Whitney U tests Kaplan-Meier, time-to-event analyses including sensitivity analyses accounting for bilateral hematomas and heterogeneous follow‑up. Results:Eighty-nine patients (117 hematomas; mean age 80.9±9.1 years; 80.9% male) were included. PVA alone was used in 29 hematomas (24.8%) and PVA with coils in 88 hematomas (75.2%). Retreatment was not required in 90.6 % of hematomas. Radiological success (complete resorption or residual thickness <10 mm) was achieved in 71.0%. Mean baseline hematoma width was 19.2 ± 6.7 mm. Across all hematomas, the median individual reduction in width from baseline to last follow-up was 77.3 % (p < 0.001). The proportion of patients with mRS<3 improved significantly from 52.8% pre-intervention to 76.4% at last follow-up (p<0.001). Dyna-CT fluid level was associated with secondary radiological outcome in unadjusted analysis (p=0.002). PVA alone versus PVA with coils showed no difference in primary outcome or secondary outcomes. Procedure-related clinical complications occurred in 1.7% of embolizations (2/117). Conclusion:MMAE with small PVA particles (45-150 µm), with or without coils, is safe and effective for cSDH patients. The low clinical complication rate and absence of procedure-related mortality, combined with favorable survival, support small PVA particles as an effective embolic agent for MMAE in routine clinical practice. Key Points:· Small PVA particles (45-150 µm): 90.6% primary success, 77.3% median hematoma reduction. mRS<3 improved significantly from 52.8% to 76.4% post-MMAE (p<0.001). Dyna-CT fluid level was associated with secondary radiological outcome. Small particles feasible and associated with favorable outcomes in this cohort. Procedure-related clinical complications 1.7%; mortality 6.7% (unrelated to procedure).. Citation Format:· Zaki MZG, Berlis A, Behrens L et al. Middle Meningeal Artery Embolization with Small Polyvinyl Alcohol Particles (45-150 µm) for Chronic Subdural Hematoma: Safety, Efficacy, and Imaging Predictors. Rofo 2026; DOI 10.1055/a-2933-2186.
Purpose:To analyze the technical results and safety of preoperative embolization of pelvic bone tumors. Materials & Methods:Retrospective study analysis of a cohort of patients who underwent preoperative hypervascular, pelvic bone tumor embolization at the authors' institution between January 2008 and January 2025. Preinterventional data, including clinical, radiological, and laboratory findings, procedural angiographic and surgical data, and clinical follow-up data were collected from the patients' electronic medical records. Patient follow-ups were conducted until March 2025 or until the patient's death. Results:Twenty-three patients (11 male patients; mean age of 42 years) underwent uneventful , preoperative embolization for primary (n=15) or metastatic (n=8) pelvic bone tumor resection. A mean of 2.3 tumor feeding arteries were preoperatively embolized with complete tumor blush disappearance in n=13 (56.5%) or near-complete tumor blush disappearance with less than 10% residual tumor blush visualized in n=10 patients (43.4%). Surgical intervention was performed with a mean of 1.7 days after embolization and was associated with a mean of 1.88 L perioperative blood loss. Conclusion:Preoperative pelvic tumor embolization is a safe procedure with a mean of more than two feeding arteries identified and embolized. Key points:· Preoperative embolization is a safe procedure for pelvic bone tumors.. · Angiography identified a mean of 2.3 tumor feeding arteries embolized.. · Complete preoperative angiographic tumoral devascularization was found in 56% of patients.. · Surgical intervention after preoperative tumor embolization was associated with a mean of 1.88L perioperative blood loss.. Citation Format:· Hubrechts M, Wafa H, Sinnaeve F et al. Surgical Outcomes after Preoperative Embolization of Primary and Secondary Pelvic Bone Tumors. Rofo 2026; DOI 10.1055/a-2942-7451.
Abstract:¹⁸F-FDG PET/CT has established itself as a sensitive whole-body imaging modality used in the diagnosis of infectious and inflammatory diseases. The technique provides critical diagnostic information in complex or atypical clinical presentations. For fever of unknown origin and systemic infections, ¹⁸F-FDG PET/CT can yield clinically relevant information in approximately 50-79% of cases, even after inconclusive conventional diagnostic workup, and the diagnostic scan enables targeted therapeutic decisions. In the diagnosis of prosthetic and implant-related infections, including pacemaker, LVAD, and vascular graft infections, ¹⁸F-FDG PET/CT represents a valuable adjunct to CT and MRI; meta-analyses report sensitivity and specificity of approximately 86% for periprosthetic infections. In prosthetic valve endocarditis, it substantially improves diagnostic confidence compared to echocardiography, which is limited in the setting of prosthetic valves; the technique is recommended as an adjunct modality in the ESC endocarditis guidelines (2023), and it achieves sensitivity and specificity of 80-87%. In native valve endocarditis, ¹⁸F-FDG PET/CT demonstrates lower sensitivity. In spondylodiscitis and osteomyelitis, meta-analytic data report sensitivities and specificities of approximately 95% and 88-91%, respectively; observational data suggest an association with lower in-hospital mortality rates, without implying a causal relationship.These findings have substantially contributed to the revision of international guidelines and procedural standards. The joint guidelines of the EANM and SNMMI (2024/2025) confirm the evidence base and provide practice-oriented recommendations regarding indications, acquisition protocols, and interpretation of ¹⁸F-FDG PET/CT in infectious and inflammatory imaging. Key Points:· High sensitivity of ¹⁸F-FDG PET/CT for infection focus detection after inconclusive prior workup. · Particularly valuable in fever of unknown origin, sepsis, and implant-associated infections. · Superior performance in prosthetic valve endocarditis and detection of extracardiac complications. · Supported by standardized EANM/SNMMI protocols (2024/2025). Key Points:· Wachenfeld E, Weiß J, Schwarzenböck S et al. The Role of ¹⁸F-FDG PET/CT in the Diagnosis of Infectious and Inflammatory Diseases. Rofo 2026; DOI 10.1055/a-2913-6380.
Zusammenfassung Seit mehr als 20 Jahren stellt die Kontrastmittelsonografie ein wichtiges Werkzeug in der Bildgebung von Lebertumoren dar. Sie kann mit hoher Sensitivität und Spezifität die wichtigsten Lebertumore detektieren und differenzieren: zur sofortigen Abklärung zufällig gefundener Leberherde, bei bekannter maligner Grunderkrankung zur Beurteilung der Anzahl und Ausdehnung von Lebermetastasen, zur genaueren Abklärung der Leber bei chronischen Lebererkrankungen wie Zirrhose. Die Kontrastmittelsonografie der Leber unterstützt bei invasiven diagnostischen und therapeutischen Verfahren und ermöglicht die unmittelbare Erfolgskontrolle oder Visualisierung von Komplikationen. Diese diagnostischen und interventionellen Möglichkeiten bietet sie sowohl perkutan als auch intraoperativ. Ein weiteres wichtiges Einsatzgebiet stellt die posttherapeutische Verlaufskontrolle zur Beurteilung von Komplikationen oder eventueller Rezidivtumore dar. Zu den wesentlichen Vorteilen der kontrastmittelverstärkten Sonografie (CEUS) der Leber zählen – bei entsprechender Expertise – ihre rasche und kosteneffiziente Verfügbarkeit, die flexible Einsatzmöglichkeit am Patientenbett und intraoperativ, sowie ihr günstiges Sicherheitsprofil. Die Anwendung ist auch bei eingeschränkter Nierenfunktion, Schilddrüsenerkrankungen und bei Kontraindikationen gegenüber jodhaltigen oder MR-Kontrastmitteln möglich und erfolgt ohne Exposition gegenüber ionisierender Strahlung. Die CEUS stellt damit eine wertvolle Ergänzung zu CT und MRT dar, ersetzt diese jedoch nicht im Rahmen des onkologischen Stagings. Ziel dieser Arbeit ist es, einen zusammenfassenden Überblick der routinemäßigen Anwendungsmöglichkeiten der Kontrastmittelsonografie (CEUS) der Leber zu geben, veranschaulicht mit Fallbeispielen unseres Institutes.
