Abstract Background Refractory pain after knee arthroplasty without prosthetic loosening, infection, or mechanical failure remains a therapeutic challenge for which few non-surgical options are available. Genicular artery embolization (GAE) has shown promise in knee osteoarthritis, but evidence in patients treated after arthroplasty remains limited. The aim of this study was to evaluate the technical feasibility, safety, and short- to mid-term clinical outcomes of GAE using imipenem/cilastatin (IPM/CLS) in this population. Results Fifteen consecutive patients (9 men, 6 women; median age, 67 years) underwent GAE between January 2022 and December 2025 for refractory pain after total knee, unicompartmental, or isolated retropatellar arthroplasty. Hypervascular periarticular branches were embolized with an IPM/CLS suspension through common femoral arterial access. Outcomes were assessed using the Numeric Rating Scale (NRS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS), and Total Analgesic Consumption Score (TACS) at baseline and 1, 3, 6, and 12 months. Technical success was 100%. Median NRS fell from 7.0 (interquartile range, 6.0–8.0) at baseline to 1.0 at 1 month ( p < 0.001), 3.0 at 3 and 6 months, and 5.0 at 12 months ( p = 0.018). Median WOMAC decreased from 32.0 to 20.0 ( p = 0.032) and KOOS from 20.0 to 14.0 ( p = 0.041) at 12 months. TACS improved significantly through 6 months ( p ≤ 0.026); 4 of 7 patients on baseline opioids had discontinued by 12 months. At 12 months, 5 of 9 evaluable patients (56%) maintained a ≥ 2-point NRS reduction and 4 of 9 (44%) achieved a ≥ 30% reduction. Repeat embolization was performed in 3 patients (20%). No major complications occurred; minor transient adverse events occurred in 2 patients (13%): mild periarticular discomfort and self-limited skin erythema. Conclusions In this small retrospective pilot cohort, GAE using IPM/CLS appeared technically feasible and safe and was associated with early pain reduction. Sustained clinically meaningful benefit at 12 months was limited to a subset of patients, indicating variable durability. These findings should be interpreted with caution and require confirmation in larger prospective studies.

We investigated whether bridging therapy (BL) was more effective as compared to thrombectomy alone (DT) in the posterior circulation and M2 occlusions as compared to M1 occlusions in patients with acute ischemic stroke. This study is based on data from 4853 patients that were enrolled in the nationwide registry of the German Society for Neuroradiology between 2018 and 2022. Outcome measures included the relative proportion of patients with a National Institutes of Health Stroke Scale score of 0–8 at discharge, successful reperfusion defined as a modified treatment in cerebral infarction score of 2b, 2c, or 3, the occurrence of intracranial hemorrhage, embolism in another vascular territory and mortality. There were no significant differences (p < 0.05) between the groups with DT and BL in periprocedural complications, mortality and functional outcome for patients with occlusion of the M1 and M2 segment. Significant higher recanalization rates were found for the M1 segment (BL 89.3

Purpose : To evaluate the clinical outcomes and safety of selective transarterial genicular artery embolization (GAE) in patients with refractory pain following knee arthroplasty without evidence of prosthetic loosening, infection, or mechanical failure. Materials and Methods: This single-center retrospective cohort study included consecutive patients who underwent GAE for refractory post-arthroplasty knee pain between January 2022 and December 2025. Pain and functional outcomes were assessed using the Numeric Rating Scale (NRS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS) and Total Analgesic Consumption Score (TACS) at baseline and at 1, 3, 6, and 12 months. Changes from baseline were analyzed using the paired Wilcoxon signed-rank test. Complications were classified according to Society of Interventional Radiology standards. Results : Fifteen patients (median age, 67 years) underwent GAE. Median baseline NRS was 7.0 (IQR, 6.0–8.0). Significant pain reduction was observed at 1 month (median NRS, 1.0; p < 0.001) and pain reduction was most pronounced during the first 6 months, with partial attenuation at 12 months. WOMAC and KOOS scores demonstrated parallel significant improvements through 12 months (p ≤ 0.041). TACS scores improved significantly through 6 months (p ≤ 0.026). Repeat embolization was performed in 3 patients (20%). No major complications occurred; minor transient adverse events were observed in 2 patients (13%). Conclusion : Genicular artery embolization was associated with significant improvements in pain and function with a favorable safety profile in patients with refractory post-arthroplasty knee pain.

The use of paclitaxel-coated devices (PCDs) in peripheral arterial disease continues to generate interest and controversy. The PCD journey to date has been a story of highs and lows. The recently published SWEDEPAD 1 and 2 trials have rekindled discussion regarding efficacy and a potential link to mortality.

BACKGROUND AND OBJECTIVE:Length of stay is an important factor for managing the limited resources of a hospital. The early, accurate prediction of hospital length of stay leads to optimized disposition of resources, particularly in complex stroke treatment. In the present study, we evaluated different machine learning techniques in their ability to predict the length of stay of patients with stroke of the anterior circulation who were treated with thrombectomy. MATERIALS AND METHODS:This retrospective study evaluated four algorithms (support vector machine, generalized linear model, K-nearest neighbor, and random forest) to predict the length of hospitalization of 113 patients with acute stroke who were treated with thrombectomy. Input variables encompassed baseline data at admission, as well as peri-procedural and imaging data. Tenfold cross-validation was used to estimate accuracy. The accuracy of the algorithms was checked with a validation dataset. In addition to a regression analysis, we performed a binary classification analysis to identify patients who stayed longer than the mean length of stay. RESULTS:The median length of stay was 10.6 days (interquartile range 6-15). The sensitivity of the best performing random forest model was 0.8, the specificity was 0.68, and the area under the curve was 0.73 in the classification analysis. The mean absolute error of the best performing random forest model was 4.6 days in the validation dataset in the regression analysis. CONCLUSION:The length of stay of patients with acute ischemic stroke of the anterior circulation can be predicted with machine learning. Machine learning could aid in optimal resource allocation in clinical routine.

Background Takotsubo syndrome (TTS) is a condition first identified in the 1990s in the Japanese population. It is believed that 1%-2% of acute coronary syndromes are due to TTS. The pathophysiological mechanism involves acute activation of the sympathetic nervous system with a cataclysmic release of catecholamines, causing acute myocardial dysfunction.Case summary We report a case of an 18-year-old female patient who suffered an out-of-hospital cardiac arrest due to ventricular fibrillation of unknown etiology. Emergency cardiac catheterization revealed normal coronaries and hypokinesia of the apical segments. The patient was admitted to the ICU with refractory cardiogenic shock, necessitating extracorporeal life support measures. Serial echocardiograms showed rapid deterioration of left ventricular function. The diagnosis of TTS was confirmed with an early cardiovascular magnetic resonance study. A corrected QT interval (QTc) prolongation was observed intermittently. The patient showed an excellent neurological outcome and was discharged after implantable cardioverter defibrillator implantation for ambulatory care. Genetic testing revealed a previously unpublished KCNH2 gene mutation. Mutations in this gene are known to cause long QT syndrome (LQTS).Discussion Our case presents a secondary TTS after surviving a sudden cardiac arrest in a teenager with so far unknown LQTS2-associated ventricular fibrillation. We emphasize the importance of repeated electrocardiogram recordings and serial echocardiography in unexplained cardiogenic shock. Our case highlights the importance of an early multimodal therapeutic approach in the management of TTS to improve patient outcomes in this complex clinical entity.

Over the last 30 years (Haaga 2005), computed tomography (CT) has developed into a well-accepted and widely used guiding tool for a broad range of percutaneous interventions. It can be used either as an alternative to sonography or fluoroscopy or if interventions cannot be done under sonographic or fluoroscopic guidance. In general, CT-guided interventions may be divided into diagnostic interventions and therapeutic interventions, although there are overlaps.

After SARS-CoV-2 infection, a subset of patients experience persistent cardiac symptoms, yet data on long-term cardiac involvement and clinical outcomes in the post-COVID-19 condition remain limited. This study aimed to investigate myocardial abnormalities using advanced cardiovascular magnetic resonance (CMR) imaging techniques in patients with ongoing cardiac symptoms for at least three months following COVID-19 diagnosis, and to assess their clinical outcomes. Between January 2021 and March 2022, 94 post-COVID-19 patients were examined at a median of 99 days (IQR 92–110) after diagnosis and compared to 100 controls. The CMR assessment included the left ventricular ejection fraction (LVEF), myocardial T2 signal, late gadolinium enhancement (LGE), and myocardial strain parameters. Follow-up for major adverse cardiac events (MACEs) was conducted at a median of 269 days (IQR 144–352). While no significant differences in LVEF were observed, post-COVID-19 patients demonstrated significantly reduced peak radial and circumferential strain values, suggesting subclinical myocardial dysfunction. Additionally, these patients exhibited a higher event rate compared to controls (0.063 vs. 0; p = 0.029). These findings indicate that patients with cardiac symptoms following COVID-19 may exhibit subtle but measurable myocardial changes and an increased risk of adverse outcomes. The observed alterations in myocardial strain most likely reflect mild, subclinical myocardial involvement within the spectrum of post-COVID-19 effects, rather than a direct cause of persistent symptoms. Further research is warranted to determine the prognostic significance of these findings.

To describe the outcomes of a survey conducted among CIRSE members on endovascular aortic repair and to outline the future practice and needs of CIRSE members in this area. An anonymous online survey with 21 questions was designed by the authors and sent to CIRSE members worldwide; data were collected for 12 weeks. The survey collected 326 complete responses, with most respondents practicing in Europe. Two-thirds of respondents indicated that aortic repair is performed by multidisciplinary teams including IRs, with more than half reporting that they are equal partners in performing the procedure, and 27

Traditionally, CT has been the go-to method for visualizing bone structures, while MRI has been preferred for assessing soft tissues, because structures containing tightly bound water molecules - such as bones, tendons, cartilage, and ligaments - produce a rapidly decaying T2* signal, which conventional MRI sequences fail to capture. To address this limitation, spoiled gradient echo sequences were refined, and short-TE sequences were introduced, enabling radiation-free bone imaging. This advance is particularly crucial for pediatric patients and in scenarios where an MRI-only approach is preferred, such as in radiation-sensitive cases and surgical planning.A comprehensive literature review was conducted by searching the PubMed and Google Scholar databases, using specific keywords: "black bone MRI" or "sCT bone" (Synthetic CT), "ZTE" (zero echo time), "UTE" (ultrashort echo time), "VIBE" (Volumetric Interpolated Breath-hold Examination), "FRACTURE" (FFE resembling a CT using restricted echo-spacing) and for title and abstract queries. The selection criteria included scientific articles published in English and German. The research was focused on the advances of the past five years in the application of the sequences in the area of the skull and spine. To support the technical understanding, earlier publications were also examined to offer readers essential background on the fundamental principles of the sequences, helping them better comprehend recent advances. For the investigation of the recent applications of the sequences, a narrow five-year time frame was applied, resulting in approximately 250 findings. From these, publications focused on the skull and spine regions were selected, with an emphasis on covering various pathologies and a preference for studies that compare different gradient echo sequences. To explore the technical aspects of the sequences, a broader time frame of ten years was selected, yielding approximately 868 results. From these, studies with more general explanations - avoiding in-depth physical and computer science details - were chosen. Using these selection parameters, 69 studies were highlighted.The gradient echo technique enables rapid and adaptable imaging, which can be customized to highlight specific tissue types. Spoiled GRE sequences such as VIBE, STAR/VIBE, and FRACTURE provide enhanced bone-to-soft tissue contrast, particularly when used with Dixon reconstruction. Short-TE sequences like UTE and ZTE utilize fast gradient switching, low flip angles, and non-Cartesian acquisition to improve bone visualization while suppressing soft tissue signals. These methods can effectively detect traumatic, neoplastic, and degenerative changes, offering CT-like imaging capabilities when patient-specific factors and the region or pathology of interest are properly considered. Additionally, integrating bone-selective sequences with deep learning could further enhance diagnostic accuracy and potentially replace CT. · Short TE-sequences achieve better bone/soft tissue contrast, but are more computationally demanding.. · ZTE is the sequence of choice for skull vault pathology, preoperative spine and skull imaging and is a preferable base for neural networks in sCT generation.. · Modified UTE sequences excel in viscerocranium and spine imaging DURANDE for bone/air-interface, 3D-stack of stars UTE with Dixon reconstruction for spine pathologies, replacing the conventional MRI sequences.. · VIBE/STAR-VIBE for facial preoperative and traumatic imaging, where motion artifacts are problematic.. · Bone and ligament matrix quantification with Dual echo and IR-UTE-Cones sequence, emitting porosity index, suppression ratio, and mapping values.. · Kavrakova IG, Haage P, Stueckle CA. Current State-of-the-Art 3D MRI Sequences for Assessing Bone Morphology with Emphasis on Cranial and Spinal Imaging: A Narrative Review. Rofo 2025; DOI 10.1055/a-2673-4339.

PURPOSE:To describe the outcomes of a survey on the provision of interventional radiology procedures for the treatment of acute pulmonary embolism (PE) in Europe and beyond. METHODS:An online survey with 14 structured items was designed by the authors and was sent to 7116 CIRSE members via email. The anonymous online survey collected data for eight weeks; only complete responses were statistically analysed. RESULTS:The survey was completed by 373 members (5.24%). Among these, 75.1% worked at centres offering catheter-directed thrombolysis or thrombectomy, in which 89.3% (250) personally perform endovascular treatment techniques for pulmonary embolism and the IR department is primarily responsible for the endovascular treatment techniques of PE in 83.2% of cases. The most frequently used endovascular techniques were (large bore) aspiration thrombectomy (85%) and catheter-directed thrombolysis (58.9%). The most common indications for intervention were sub-massive and massive PE (69.9%) and massive PE only (28%). In 70% of centres offering catheter-directed thrombolysis or thrombectomy, three or more Interventional Radiologists (IRs) are involved in PE treatment. Multidisciplinary rapid response teams for PE were available in 40.8% of centres, and included IRs in 91.4%. CONCLUSION:IRs are heavily involved in the management of patients with massive and sub-massive pulmonary embolism; further research is mandated to address clinical questions including patient selection and the timing for transcatheter therapies of PE provided by IR.

Peripheral arterial disease (PAD) is a prevalent and increasingly common condition associated with high morbidity and a growing number of patients worldwide. Atherectomy, a minimally invasive technique to remove or modify atherosclerotic plaques, has gained popularity as an adjunct to vessel preparation before balloon angioplasty, particularly in combination with drug-coated balloons (DCB). Its therapeutic role in PAD appears promising but requires further investigation. A systematic literature search was conducted in the PubMed database. Randomized controlled trials, meta-analyses, registry data, and guideline recommendations regarding atherectomy in PAD were included. The aim was to evaluate evidence on efficacy, safety, and clinical relevance across different anatomical regions and different atherectomy devices. Atherectomy shows promise as an adjunctive technique in the endovascular treatment of PAD, particularly for complex and calcified lesions in the femoropopliteal segment. While some observational and registry data suggest improved procedural success, luminal gain and reduced need for bailout stenting, randomized controlled trials yield mixed results regarding long-term patency and clinical benefit. In below-the-knee interventions, evidence remains limited and complication rates are of concern. Overall, atherectomy represents a valuable tool within a tailored treatment approach but requires further clinical validation through high-quality trials to clearly define its therapeutic role.

ObjectiveThe cause of late-onset first epileptic seizures (LOFES) in older age is often not readily evident. In absence of probable causes, it has been suggested that cerebral small vessel disease (CSVD), which is common with increasing age, may be crucial. We aimed to further investigate the impact of white matter lesion (WML) burden and distribution pattern on LOFES.MethodsWe retrospectively compared structural MRI of LOFES patients (n = 39) aged 60 years or older to controls with a transient ischemic attack (TIA, n = 38) and to patient controls (n = 35). WML segmentation was performed on FLAIR images using the SPM based automated lesion prediction algorithm of the LST toolbox and careful manual adjustment. Further, a dichotomization of WML was achieved by use of the BIANCA masking function. A voxel-based morphometry (VBM) analysis was additionally performed on T1 weighted sequences using the automated SPM12 based CAT12 software.ResultsComparing intrapersonal volume ratios adjusted for the effects of gender and age, we found that the WML distribution was shifted to the juxtacortical compartment in LOFES patients. Among several influencing variables a path analysis could additionally show that this juxtacortical weighting of WML was a significant predictor for LOFES (β = 0.509, p < 0.001). With regard to total WML volume, LOFES and TIA patients did not differ significantly. Compared to TIA group, LOFES patients gray matter volume was regionally decreased in the right pre- and postcentral gyrus.SignificanceBy using algorithm-based automated lesion segmentation software tools and VBM analysis we could highlight that a juxtacortical weighting of WML distribution and regionally decreased gray matter volume distinguished LOFES from TIA and PC groups in our sample.

Background and objectives Pulmonary manifestation of coronavirus disease 2019 (COVID-19) is described using standardized computed tomography (CT) morphologic criteria. In this study, we investigated possible associations between thoracic CT manifestations in COVID-19 pneumonia and typical comorbidities, as well as clinical course.Methods We analyzed clinical data and pulmonary imaging of 61 patients with positive PCR test. Pulmonary changes were categorized and reviewed for associations with pre-existing comorbidities and clinical course.Results Compared to patients with atypical infiltrate patterns (2/19, 10.5%), 25 patients with typical infiltrate patterns (25/42, 59.5%) were significantly more likely to receive intensive care (p<0.001). In addition, patients with typical infiltrate patterns were more likely to receive non-invasive ventilation (12/42, 28.6%, p=0.040) and high-flow therapy (8/42, 19%, p=0.041) compared to patients with atypical infiltrate patterns. Mortality was also higher in patients with typical infiltrate patterns, with 15 patients (15/42, 35.7%) dying during follow-up compared to only 1 patient with atypical infiltrate pattern (1/19, 10.5%, p=0.012). No significant association between specific comorbidities and the resulting infiltrate pattern could be demonstrated.Conclusions Patients with a typical COVID-19 infiltrate pattern are more likely to receive intensive care and show higher mortality rates. Further analysis with larger patient collectives is needed to identify specific risk factors for typical COVID-19 pneumonia.

Background Large volumes of data increasing over time lead to a shortage of radiologistsʼ time. The use of systems based on artificial intelligence (AI) offers opportunities to relieve the burden on radiologists. The AI systems are usually optimized for a radiological area. Radiologists must understand the basic features of its technical function in order to be able to assess the weaknesses and possible errors of the system and use the strengths of the system. This “explainability” creates trust in an AI system and shows its limits. Method Based on an expanded Medline search for the key words “radiology, artificial intelligence, referring physician interaction, patient interaction, job satisfaction, communication of findings, expectations”, subjective additional relevant articles were considered for this narrative review. Results The use of AI is well advanced, especially in radiology. The programmer should provide the radiologist with clear explanations as to how the system works. All systems on the market have strengths and weaknesses. Some of the optimizations are unintentionally specific, as they are often adapted too precisely to a certain environment that often does not exist in practice – this is known as “overfitting”. It should also be noted that there are specific weak points in the systems, so-called “adversarial examples”, which lead to fatal misdiagnoses by the AI even though these cannot be visually distinguished from an unremarkable finding by the radiologist. The user must know which diseases the system is trained for, which organ systems are recognized and taken into account by the AI, and, accordingly, which are not properly assessed. This means that the user can and must critically review the results and adjust the findings if necessary. Correctly applied AI can result in a time savings for the radiologist. If he knows how the system works, he only has to spend a short amount of time checking the results. The time saved can be used for communication with patients and referring physicians and thus contribute to higher job satisfaction. Conclusion Radiology is a constantly evolving specialty with enormous responsibility, as radiologists often make the diagnosis to be treated. AI-supported systems should be used consistently to provide relief and support. Radiologists need to know the strengths, weaknesses, and areas of application of these AI systems in order to save time. The time gained can be used for communication with patients and referring physicians. Key Points Citation Format

PURPOSE:Outcome prediction of large vessel occlusion of the anterior circulation in patients with wake-up stroke is important to identify patients that will benefit from thrombectomy. Currently, mismatch concepts that require MRI or CT-Perfusion (CTP) are recommended to identify these patients. We evaluated machine learning algorithms in their ability to discriminate between patients with favorable (defined as a modified Rankin Scale (mRS) score of 0-2) and unfavorable (mRS 3-6) outcome and between patients with poor (mRS5-6) and non-poor (mRS 0-4) outcome. METHODS:Data of 8395 patients that were treated between 2018 and 2020 from the nationwide registry of the German Society for Neuroradiology was retrospectively analyzed. Five models were trained with clinical variables and Alberta Stroke Program Early CT Score (ASPECTS). The model with the highest accuracy was validated with a test dataset with known stroke onset and with a test dataset that consisted only of wake-up strokes. RESULTS:2419 patients showed poor and 3310 patients showed favorable outcome. The best performing Random Forest model achieved a sensitivity of 0.65, a specificity of 0.81 and an AUC of 0.79 on the test dataset of patients with wake-up stroke in the classification analysis between favorable and unfavorable outcome and a sensitivity of 0.42, a specificity of 0.83 and an AUC of 0.72 in the classification analysis between poor and non-poor outcome. CONCLUSION:Machine learning algorithms have the potential to aid in the decision making for thrombectomy in patients with wake-up stroke especially in hospitals, where emergency CTP or MRI imaging is not available.

Background The diagnosis and treatment of specific back pain is important in radiology. Due to the high number of patients suffering from back pain, it is important to provide excellent diagnostic and therapeutic support. Method Based on a recent literature search and considering the relevant guidelines as well as expert opinions, the aspects of specific back pain important for radiologists in terms of pathogenesis, diagnosis, and treatment are presented. Results Clinical examination in combination with the medical history provides a valid suspected diagnosis. This should subsequently be verified radiologically. MRI is the most effective cross-sectional diagnostic method for investigating specific back pain. A conventional X-ray on two planes in a standing position can be a useful addition if postural causes are suspected. If the clinical symptoms match the morphological findings, radiological treatment can be carried out for nerve root involvement as well as for inflammatory changes of the facet joints. The improvement in symptoms after radiological therapy is considered good overall; at least a short-term improvement in symptoms can generally be achieved, but no reliable data is available regarding the long-term outcome. Using preparations containing triamcinolone, low dosages should be selected in accordance with the guidelines. Embedding in a multimodal pain therapy treatment concept should be considered. Conclusion Radiology provides essential diagnostic findings regarding specific back pain. Interventional pain therapy is an effective and safe method of treating proven specific back pain.