This systematic review and meta-analysis evaluated pain and functional outcomes, safety, and differences between embolic agents in genicular artery embolization (GAE) for knee osteoarthritis. Forty-five studies including 2205 patients were analyzed. Across predominantly uncontrolled studies, clinically relevant improvements were observed, with pooled Visual Analogue Scale reductions of − 37.5 points at 1 month and − 37.1 at 12 months. Western Ontario and McMaster Universities Osteoarthritis Index improved by − 28.9 at 1 month, and Knee Injury and Osteoarthritis Outcome Score-Pain by + 23.6 at 6 months. Mean changes exceeded clinically important thresholds. No significant subgroup interaction between permanent and temporary embolic agents was observed. The most frequent adverse events were transient skin discoloration (11

To identify a quantitative surrogate parameter for the embolic endpoint in genicular artery embolization (GAE). Digital subtraction angiography (DSA) images were fused and converted into color maps. Using segmentation software, blush size was measured before and after embolization, and blush reduction ratio (BRR) was calculated. Osteoarthritis severity was graded on radiographs, and clinical outcome was evaluated using the Knee Injury and Osteoarthritis Outcome Score (KOOS) at 6 weeks, 3 months, and 6 months. Embolized vessels and embolic volume were recorded. Blush size and BRR were compared between osteoarthritis grades and across embolized vessels. GAE using 100–300 µm permanent microspheres was performed in 90 patients with mild to severe osteoarthritis and 23 patients with pain after total knee replacement (post-TKR) (404 vessels). The median number of vessels embolized per session was 4 (range: 1–6) with a median total embolic volume of 3.5 mL (1.1–8.0 mL). Pre-embolization blush size (+ 1116 mm²/osteoarthritis grade; p < 0.0001) and embolic volume (+ 1.1 mL/OA grade; p < 0.0001) increased with higher osteoarthritis grade and post-TKR. Blush size significantly decreased after embolization (p < 0.0001) with a median BRR of 0.81 (0.62–0.94). No significant differences in BRR were observed between osteoarthritis grades and different vessels. All KOOS subscales improved significantly at each follow-up (p < 0.0001). Segmentation of blush size enables quantitative assessment of embolic endpoints across all genicular arteries and osteoarthritis grades, including post-TKR cases. “Pruning” corresponds to a blush size reduction of 80

BACKGROUND:Chronic tendinopathies are common causes of persistent musculoskeletal pain. In refractory cases, pathological hypervascularization and neo-innervation play a key role in pain generation. Transarterial microembolization (TAME) aims to reduce this abnormal vascularity using a minimally invasive approach. PURPOSE:This review summarizes current evidence regarding the efficacy and safety of TAME in selected tendinopathies. MATERIALS AND METHODS:A narrative review of recent literature on TAME for adhesive capsulitis, medial and lateral epicondylitis, Achilles tendinopathy, and plantar fasciitis was conducted, focusing on technical aspects, embolic agents, and clinical outcomes. RESULTS:Available studies consistently demonstrate significant pain reduction and functional improvement following TAME across all indications. The strongest evidence exists for adhesive capsulitis and Achilles tendinopathy, with reported clinical success rates of approximately 80-90%. Procedures are typically performed catheter-guided using a superselective approach and temporary embolic agents, most commonly imipenem/cilastatin. No major complications have been reported. CONCLUSION:TAME represents a safe and effective minimally invasive treatment option for selected refractory tendinopathies and may bridge the gap between conservative management and surgery. Further randomized controlled trials are required to define long-term outcomes and optimal patient selection.

Abstract:The increasing complexity of interventional radiology procedures, combined with limited anesthesiology resources, makes it essential for interventional radiologists to independently provide safe and effective sedation and analgesia. To ensure responsible and timely patient care, a structured and comprehensive development of these competencies within interventional radiology is necessary. While established guidelines and training curricula exist in fields like gastroenterology and cardiology, comparable standards are still lacking in German-speaking countries for radiology. This position paper highlights the urgent need to develop a unified curriculum for sedation and pain management tailored to interventional radiology. This curriculum should be integrated into specialist and assistant training programs. Beyond clinical education, the availability of adequate infrastructure, standardized workflows, clear documentation, and emergency protocols are critical for ensuring patient safety. Collaboration with anesthesiology departments, particularly in complex or deep sedation cases, remains indispensable. Sedation performed by radiology teams is not intended to compete with anesthesiology, but rather to augment patient care capacity in a structured and safe manner. Expanding these competencies strengthens the autonomy of interventional radiology, supports the broader trend toward outpatient care, and enables timely, efficient, and comfortable procedures. This represents an important step in establishing interventional radiology as an independent clinical discipline actively involved in patient treatment. Key Points:· Growing need for autonomous analgosedation in IR - The increasing complexity of interventional radiology procedures combined with limited anesthesiology capacity makes competent sedation and analgesia performed by the IR team itself essential for timely and patient-centered care.. · International evidence supports safety and feasibility - Multiple guidelines (CIRSE, ASA, ESAIC, RCR) and recent studies - including CT-guided brachytherapy and percutaneous tumor ablation - confirm that non-anesthesiologist-administered sedation can be performed safely and effectively.. · Clear risk stratification and sedation boundaries - Minimal and moderate sedation in ASA I/II patients can be independently performed by trained interventional radiologists; deep sedation remains the domain of anesthesiologists or intensivists. Standardized patient selection and pre-procedural risk assessment are mandatory.. · Infrastructure, training, and documentation as minimum requirements - Standardized operating procedures, continuous monitoring, dedicated sedation personnel, regular simulation-based training, and structured post-procedural care - including a recovery unit and discharge management - are non-negotiable prerequisites.. · Urgent need for binding standards in the DACH region - While internationally established guidelines exist, comparable mandatory curricula and standards for IR are currently absent in German-speaking countries. This position paper provides the first practice-oriented recommendations and calls for the rapid development of competency frameworks within IR departments.. Citation Format:· Minko P, Auer TA, Gebauer B et al. Analgosedation in interventional radiology. Rofo 2026; DOI 10.1055/a-2863-2198.

Background/Objectives: To evaluate the diagnostic potential of apparent diffusion coefficient (ADC) values for classifying lymph nodes as benign or malignant in breast cancer patients undergoing [18F]FDG-PET/MRI staging. Methods: Mean ADC values and short-axis diameters (±standard deviation) of 199 thoracic lymph nodes in 113 newly diagnosed breast cancer patients were retrospectively analyzed. All patients underwent [18F]FDG-PET/MRI staging, between July 2017 and June 2021. A node-by-node comparison was performed with respect to pathological node status. Nodal FDG uptake in whole-body [18F]FDG-PET/MRI served as reference standard for nodal malignancy. Group comparison using Mann–Whitney U test, receiver operating characteristic curve (ROC) analysis and diagnostic performance were calculated. p values below 0.05 were defined as statistically significant. Confidence intervals (CI; 95%) were calculated. Results: Ninety-three lymph nodes were FDG-negative while 106 lymph nodes were FDG-positive. FDG-negative lymph nodes had significantly lower short-axis diameters ((5.1 ± 1.5 mm versus 12.3 ± 5.3 mm); p < 0.01; U: 405.50; Z: −11.24). ADC values were significantly lower in FDG-positive lymph nodes (0.72 ± 0.14 × 10−3 mm2/s) than in FDG-negative lymph nodes ((1.18 ± 0.18 × 10−3 mm2/s); p < 0.01; U: 173.00; Z: −11.80). ROC analysis and Youden’s index revealed an ADC cut-off of 0.95 × 10−3 mm2/s (AUC: 0.98; p < 0.01; 95% CI: 0.96–1.01). According to the calculated cut-off, sensitivity, specificity, and accuracy of ADC values for differentiating FDG-negative from FDG-positive lymph nodes were 98%, 97% and 97%, respectively. Conclusions: ADC values derived from MRI were significantly associated with FDG uptake in this retrospective cohort and may serve as a complementary imaging biomarker for lymph node characterization.

Die transarterielle Mikroembolisation (TAME) ist ein zunehmend etabliertes minimalinvasives Therapiekonzept bei chronischen Gelenkschmerzen, insbesondere am Kniegelenk. Der interventionelle Erfolg der Genikulararterienembolisation (GAE) wird dabei maßgeblich durch die komplexe Anatomie, Gefäßvarianten und ein ausgeprägtes Anastomosennetzwerk bestimmt. Ziel dieser Übersichtsarbeit ist es, die relevanten Zielgefäße der GAE darzustellen. Besonderes Augenmerk liegt auf anatomischen Varianten und Anastomosen, die die Zielgefäßwahl, Katheterisierung und Sicherheit der GAE beeinflussen. Narrative Literaturübersicht basierend auf aktuellen angiographischen, anatomischen und klinischen Studien zur GAE, mit Fokus auf Gefäßverlauf, Varianten und funktioneller Bedeutung des Anastomosennetzwerks. Am Knie werden die deszendierende Genikulararterie (GA), superomediale GA, inferomediale GA, superolaterale GA, inferolaterale GA und die A. recurrens tibialis anterior als wesentliche Zielgefäße identifiziert, die eine hohe Variabilität und zahlreiche Anastomosen aufweisen. Dies erklärt, warum die Embolisation einzelner GA keinen klinischen Vorteil gegenüber Placebo zeigt und weshalb möglichst alle GA adressiert werden müssen. Der klinische Erfolg der GAE hängt maßgeblich von einem fundierten Verständnis der Anatomie ab. Ein strukturiertes Vorgehen bei der Auswahl der Zielgefäße und Kenntnis der anatomischen Varianten und Anastomosen ist Voraussetzung für eine sichere, vollständige und effektive GAE.

Knee osteoarthritis (KOA) is a prevalent musculoskeletal condition characterized by a significant therapeutic gap between the failure of conservative medical therapies and surgical arthroplasty. Contemporary evidence supports a model in which chronic synovitis and pathologic neoangiogenesis, closely coupled to perivascular nociceptive nerve growth, serve as significant contributors of pain and peripheral sensitization in KOA. Genicular artery embolization has emerged as a targeted, joint-preserving vascular intervention performed by interventional radiologists that directly addresses the inflammatory and neurovascular components of KOA. The purpose of this societal-endorsed position statement is to synthesize the current knowledge base for genicular artery embolization and review its biologic rationale, clinical evidence, technical considerations, safety profile, and evolving regulatory landscape.

Visceral artery aneurysms (VAA) are rare, and data on their occurrence and treatment are often outdated or heterogeneous. The objective of this study is to provide a comprehensive overview of features and interventional treatment options for VAA.We analyzed demographic, procedural, and clinical data on VAA from 2018 to 2022 based on data derived from the German Society for Interventional Radiology and Minimally Invasive Therapy (DeGIR) registry regarding demographic details, aneurysm characteristics, treatment processes, and outcomes such as technical success, complication rates, and radiation exposure. Group comparisons between aneurysm locations and types were calculated as dependent variables as well as occurrence of incomplete embolization, complication rates, technical success, duration of intervention, and dose-area-product (DAP).In total 647 patients were enrolled. The mean age was 66 years, with 68.5% male. The most affected arteries were splenic (27.5%) and renal (21.3%). True aneurysms were most common (56.7%). Technical success was 91.2%, while primary incomplete embolization occurred in 47.3%. Complications were observed in 4.8%, with a 0.2% mortality. Mean intervention duration was 67 min, mean fluoroscopic time was 36 min and mean DAP was 9560 cGycm2. There were no significant differences in primary incomplete embolization, complication rate, correct placement of embolization material, duration, and DAP based on aneurysm location. Aneurysm types showed a significant difference in incomplete embolization, with dissections having the highest rates and longest durations of intervention and highest DAP.The analysis of DeGIR quality management data reveals consistently high technical success and low complication rates in endovascular treatment of VAA. Dissecting aneurysms exhibit the highest rates in incomplete embolization, requiring the longest interventions and increased radiation. Enhancing the DeGIR registry with follow-up features would benefit assessing VAA occlusion rates. The data provide a comprehensive nationwide overview of how interventional radiology can impact treatment strategy. · Visceral artery aneurysms represent a rare entity. · The DeGIR registry provides extensive data about rare endovascular treatments of visceral artery aneurysms. · Endovascular treatment of visceral aneurysms is feasible and safe. · Dissecting aneurysms are associated with the highest rates of primary incomplete embolization and the longest interventional durations. · Weiss D, Jannusch K, Wilms LM et al. Endovascular Treatment of Visceral Artery Aneurysms: Data Analysis of the DeGIR/DGNR Quality Management System. Rofo 2025; 197: 1291-1299.

Genicular artery embolization (GAE) is an emerging, minimally invasive therapy for refractory knee osteoarthritis (OA), targeting pathological synovial hypervascularization. While technically well established in typical anatomy, rare congenital anomalies such as popliteal artery (PA) agenesis present unique procedural challenges and demand careful adaptation of endovascular technique. A 56-year-old woman with refractory right knee OA and polymyalgia rheumatica presented with persistent pain despite extensive medical and surgical therapies. Angiography revealed complete absence of the PA, with distal lower limb perfusion entirely maintained through a dense network of arterial anastomoses. Detailed angiographic assessment and superselective catheterization allowed targeted embolization of hypervascular synovial branches while preserving critical collaterals. The procedure was technically successful and uneventful, providing substantial pain relief within two weeks, maintained at 3, 6, and 12 months. At 18 months, symptoms recurred and repeat GAE was considered. However, the symptoms resolved spontaneously, and no further embolization was required. Only mild swelling on exertion persisted. At the two-year follow-up, the patient reported sustained pain relief without further interventions. This case illustrates that GAE can be safely and effectively performed even in the presence of rare congenital vascular anomalies such as PA agenesis. Meticulous angiographic assessment, precise differentiation of synovial from distal perfusion territories, and a tailored embolization strategy are essential to achieve safe and durable outcomes in such anatomically challenging scenarios. This case report underscores the adaptability of endovascular techniques and expands the evidence base for GAE in patients with rare vascular variants.

Objectives:The aim of this study is to evaluate the potential of [18F]FDG-PET/CT in terms of prognostic value and treatment monitoring in relapsed / refractory diffuse large B-cell lymphoma (DLBCL)-patients treated with chimeric antigen receptor T-cell (CAR-T) therapy. Material & methods:Forty-eight [18F]FDG-PET/CT scans, acquired at pre-defined time points (t0 - t2) of 18 DLBCL-patients (mean age: 60 ± 12 years) treated with CAR-T cell therapy were retrospectively enrolled. Median time of follow-up was ten months (IQR 6-16) following CAR-T cell infusion. SUVmax, sum of the product of diameters (SPD), Deauville score (DS) and Lugano classification (LC) were evaluated. Clinical parameters (age, sex) were obtained. Survival time analyses for progression-free survival (PFS) and overall survival (OS) were calculated, the latter by using the Kaplan-Meier method and Cox regression including a hazard ratio (HR). P values below 0.05 were defined as statistically significant. 95 %-confidence intervals (CI) were calculated. Results:Patients with a SUVmax> 9.0 at t0 (median as threshold value) had a significantly shorter PFS (p = 0.04) and OS (p < 0.01). According to LC, a progressive disease (PD) at t1 (p = 0.02) and t2 (p < 0.01) was correlated with a reduced OS. SUVmax > 9.0 at t0 (p = 0.03, HR = 7.0, CI: 1.3-40.5) and DS > 3 at t1 (p = 0.04, HR = 8.2, CI: 1.1-61.3) were associated with an increased risk of a PD. Conclusion:SUVmax of [18F]FDG-PET/CT seems to be useful as a prognostic marker in DLBCL-patients undergoing CAR-T cell therapy. Furthermore, scores of clinical established Deauville classification and Lugano response criteria acquired at post-CAR-T [18F]FDG-PET/CT might be an indicator for early therapy failure.

Background/Objectives: The transjugular intrahepatic portosystemic shunt (TIPS) is an established treatment for complications of portal hypertension in patients with liver cirrhosis. While its use has increased and indications have broadened in recent years, recent comprehensive data on patient characteristics, trends, and in-hospital mortality in Germany are lacking. This study aimed to evaluate current clinical patterns and mortality outcomes associated with TIPS. Methods: This nationwide cross-sectional study used anonymized hospital data from the German InEK database between 2019 and 2023. TIPS procedures were identified using relevant OPS codes. Patient demographics, liver cirrhosis stage (Child–Pugh), hepatic encephalopathy grade, comorbid conditions, and in-hospital mortality were analyzed descriptively. Analyses were conducted using SAS 9.4. Results: A total of 12,905 TIPS procedures were documented. Annual case numbers rose from 2180 in 2019 to 2954 in 2023. Most patients were male (66.3%) and aged 60–74 years. Ascites (68.6%) was the most frequent associated diagnosis, followed by variceal bleeding (16.4%) and hepatorenal syndrome (14.9%). The average hospital stay decreased from 19.6 to 16.8 days. Overall in-hospital mortality was 8.5%, increasing with age (13.0% in ≥75 years), Child–Pugh C cirrhosis (14.9%), PCCL grade 4 (17.6%), hepatorenal syndrome (16.7%), and grade 4 hepatic encephalopathy (56.1%). Conclusions: TIPS usage in Germany has increased over the past five years, with a shift toward earlier disease stages. Higher in-hospital mortality in clinically complex patients underscores the importance of careful patient selection and tailored management strategies in high-risk groups.

Chronische Gelenkschmerzen sind eine der häufigsten Ursachen für Bewegungseinschränkungen und reduzierte Lebensqualität. Ihr Ursprung liegt häufig in einer chronischen unterschwelligen Entzündung der Synovialmembran. Dabei spielt eine pathologische periartikuläre Neovaskularisation eine zentrale Rolle. Sie fördert nicht nur die Entzündung, sondern begünstigt auch das Wachstum schmerzleitender Nervenfasern. Hier setzt die transarterielle Mikroembolisation (TAME) an – ein minimalinvasives radiologisches interventionelles Verfahren, das gezielt die krankhafte Hypervaskularisation in betroffenen Gelenken reduziert. Indem sie diese pathologischen Gefäßbündel („vascular blush“) kathetergestützt verschließt, unterbricht die TAME den Teufelskreis aus Entzündung, Nervenneubildung und Schmerz. Insbesondere bei chronischen Knieschmerzen zeigt die TAME in Form der Genikulararterienembolisation (GAE) vielversprechende Ergebnisse. Mehrere prospektive Studien,– darunter auch randomisierte kontrollierte Studien, belegen die Wirksamkeit im Vergleich zu Placebo-Verfahren. Die TAME eröffnet somit insbesondere jenen Patienten eine neue Perspektive, bei denen konservative Therapiemaßnahmen ausgeschöpft sind. Inzwischen setzt man die TAME nicht nur am Knie, sondern zunehmend auch an Schulter, Hüfte, Ellenbogen und Sprunggelenk ein – mit ebenso überzeugenden Ergebnissen. Dieser Artikel gibt einen Überblick über die aktuellen Erkenntnisse zur TAME – mit Fokus auf die GAE. Ein innovativer Therapieansatz mit dem Potenzial, die Schmerztherapie grundlegend zu verändern.

Acute type-A aortic dissection with malperfusion syndromes represents challenging cases and should always be treated on an interdisciplinary basis, whereby interventional radiologic therapy can be a successful procedure, especially in patients who are not fit for surgery.