Rationale and objectives:To evaluate if higher contrast medium injection pressure can improve image quality of digital subtraction angiography (DSA) in liver-directed interventions. Materials and methods:Prospective single-center study including twelve patients with hepatocellular carcinoma (n = 11) or liver metastases (n = 1) undergoing intra-arterial therapies to systematically compare DSA image quality (primary endpoint) and radiation exposure (secondary endpoint) using two microcatheters with maximum application pressures 750 ("C750") and 1,200 PSI ("C1200"). Patients underwent two DSAs with both microcatheters placed in the common hepatic artery. Application pressure, contrast medium flow, volume, and dose area product were recorded. Image quality was evaluated using a customized questionnaire and quantified by calculating signal- and contrast-to-noise-ratios, and vessel-to-liver signal intensity ratio. Results were compared by paired t-test and Wilcoxon Signed-Rank test. Results:Image quality using C1200 (achieved 917 ± 94 PSI) was rated more favorably than C750 (731 ± 45 PSI). C1200 reached higher scores of artery visualization in 72% cases, and significantly outperformed C750 regarding tumor blush in 100% (p < 0.001). Contrast-to-noise-ratio were significantly higher in C1200 (p < 0.001) and vessel-to-liver intensity ratios were significantly lower (p = 0.001), both reflecting improved visualization and delineation of liver vessels. Signal-to-noise ratio did not differ significantly. Mean dose area product was comparable (C1200; 371.9 vs. 374.8 μGym2). Conclusion:The results suggest benefits of standardized CM injections for DSA using higher application pressure to enhance image contrast and tumor demarcation during IAT.

Abdominal aortic aneurysm (AAA) remains a life-threatening condition with few large-animal disease models. We aimed to develop a fully endovascular porcine AAA model for radiology research, reducing surgical trauma and improving reproducibility versus laparotomy-based models. Fourteen female German Landrace swine (n = 14, 30–40 kg) underwent angiography-guided intervention. The animals’ infrarenal aorta was dilated by 30

Background Genicular artery embolization (GAE) is an emerging minimally invasive therapy for osteoarthritis (OA)-related knee pain. Traditional embolic agents such as imipenem-cilastatin and permanent microspheres have distinct limitations. Rapidly resorbable gelatin-based microspheres (RRGMs), designed specifically for GAE, may offer a promising alternative. Purpose To evaluate the safety and clinical outcomes of GAE using RRGMs in participants with OA-related knee pain. Materials and Methods This prospective, single-center observational study included consecutive participants with OA-related knee pain refractory to conservative treatment who underwent GAE using RRGMs between July and November 2024. Safety, the numeric rating scale (NRS) score (range, 0-10), and the Knee Injury and Osteoarthritis Outcome Score (KOOS) (range, 0-100) were assessed at 6 weeks and 3, 6, and 12 months after treatment. Clinical benefits were evaluated using the minimum clinically important difference (MCID). Descriptive statistics were used, and changes over time were assessed with the Friedman nonparametric repeated-measures test. Results A total of 194 participants (median age, 69 years; IQR, 60.5-75 years; 114 female) underwent 239 GAE procedures using RRGMs. The follow-up rates were 94% at 6 weeks (183 of 194 participants), 89% at 3 months (172 of 194 participants), 89% at 6 months (171 of 194 participants), and 79% at 12 months (154 of 194 participants). All the procedures (239 of 239) were technically successful. Transient skin discoloration occurred after 15 procedures (6.3%), and one participant developed a superficial groin hematoma (0.4%), all of which resolved without sequelae. No moderate or severe adverse events were observed. The median NRS pain score decreased from 7 (IQR, 6-8) at baseline to 3 (IQR, 2-5) at 12 months (P < .001), corresponding to a median reduction of 4 points (95% CI: 3.5, 4.0). At 12 months, 55%-80% of participants achieved improvements exceeding the MCID across all KOOS subscores. Conclusion GAE using RRGMs is safe and is associated with clinically meaningful improvement in participants with OA-related knee pain. © The Author(s) 2026. Published by the Radiological Society of North America under a CC BY 4.0 license.

Objective: This retrospective study investigates the benefit of combining lobar radioembolization (TARE), performed using a body surface area (BSA) dose prescription model, with targeted therapy (TT) in hepatocellular carcinoma (HCC), and aims to identify predictors of response through contrast-enhanced MRI tumour volumetry. Methods: Ninety-two HCC patients who underwent TARE at our center between 10/2008 and 01/2022 and a baseline MRI within 60 days prior to TARE as well as follow-up MRI were included. Pre- and post-treatment target lesion volumes were measured as total-tumour-volume (TTV) and enhancing-tumour-volume (ETV). Kaplan-Meier analysis, Log rank tests, and Cox regression were used to assess the impact of clinical and imaging variables on time to target lesion progression and overall survival. Results: The mean patient age was 65 (SD 10) years; 67 patients had liver cirrhosis. Median overall survival (mOS) was 13 months (95% CI 11- 16). A baseline ETV/TTV ratio > 50% was associated with a median ETV reduction of 41% versus a 61% increase in those with low vascularity (p< 0.001), and a longer time to target lesion progression (28 vs 3 months, p=0.002). Of 45 patients receiving TT, 21 were treated within 2 months before TARE. In this subgroup with pre-interventional TT, high vascularity correlated with significantly improved mOS (> 17 vs 6 months, p=0.027), while no survival difference was observed in other cohorts. Conclusion: High baseline vascularization may help identify patients who benefit from conventional lobar TARE and a narrowly timed combination with TT in terms of mOS, suggesting synergistic effects in patients not eligible for resection or ablation.

Abstract Purpose Patients with liver metastases from gallbladder carcinoma have limited treatment options. This retrospective multicenter study evaluated overall survival, tumor control and safety after transarterial radioembolization in this rare patient group. Materials and methods Patients with histologically confirmed gallbladder carcinoma and liver-dominant metastatic disease treated with yttrium-90 or holmium-166 radioembolization at five tertiary centres were retrospectively identified. Baseline clinical and imaging data, details of the radioembolization procedure and follow-up imaging were collected. Tumor response was assessed locally using RECIST 1.1. Overall survival was analysed descriptively using Kaplan–Meier curves. Results Sixteen patients (9 women, mean age 65.7 ± 5.5 years) were included; 93.8% had received prior systemic chemotherapy and 75.0% had extrahepatic metastases. At approximately 3 months, hepatic disease control was achieved in 81.8% (9/11) of patients with available imaging, whereas global disease control was 36.4% (4/11). Median overall survival was 7.1 months (95% confidence interval 1.7–12.3). The median time to hepatic progression was 115 days and the median time to global progression was 112 days. Procedure-related complications were limited to one coil dislocation, one contrast reaction and one liver abscess. Conclusion Radioembolization was feasible and well tolerated in patients with liver-dominant metastases from gallbladder carcinoma and provided intrahepatic disease control in a heavily pretreated population. Given the small sample size, these exploratory findings require confirmation in prospective studies.

Abstract:In recent years, both the capabilities and the availability of endovascular emergency treatments provided by interventional radiology have expanded significantly. This development has led to a broad range of emergency indications in which endovascular therapy is now considered one of the preferred treatment options. At the same time, a 24-hour interventional on-call service has become an indispensable part of everyday clinical practice. While this represents a highly positive development for the field, it increasingly pushes routine operations to their personnel and organizational limits. This raises the central - and at the same time sensitive - question of which emergency interventions truly require immediate attention during the night hours between 10 p.m. and 7 a.m., and which procedures can be postponed safely until the following day. The following article presents six case examples and their respective clinical courses, analyzed with particular focus on emergency management. In addition to the course of events and technical implementation, the discussion will especially address the assessment of the temporal urgency of treatment. Key Points:· The urgency of emergency endovascular interventions depends on the location, morphology, hemodynamics, and coagulation status.. · Hemodynamically significant abdominal arterial bleeding requires immediate interdisciplinary assessment and, as a rule, prompt and often endovascular treatment.. · In stable patients, treatment on the following day may be acceptable and should be taken into account in local algorithms.. Citation Format:· Auer TA, Schmid A, Gebauer B. Endovascular Treatment of Abdominal Arterial Bleeding - Which Cases Require Nighttime Intervention?. Rofo 2026; DOI 10.1055/a-2868-8078.

The goal of our analysis is to provide technical information and clinical long-term data on arterial embolization for non-ischemic priapism. Furthermore, this study presents a comprehensive literature review. We analyzed patient data from June 2005 to June 2025 at a large university hospital, focusing on patients with non-ischemic priapism lasting over 1 week, unresponsive to conservative treatment, and referred for arterial embolization. Age, symptom etiology, initial diagnostic modality, embolic agent, uni- or bilateral arterial supply of the fistula/pseudoaneurysm, technical success, clinical outcome, need for a second attempt, erectile dysfunction, adverse events, and mean follow-up time needed were assessed. Findings were contextualized with studies from the past two decades. A total of 15 male patients with non-ischemic priapism due to blunt, penetrating trauma or of idiopathic origin, were included in this analysis. The embolic agents chosen included gelatin sponge, polyvinyl alcohol particles, autologous clot, microcoils, and a combination of microcoils with gelatin sponge or polyvinyl alcohol particles. Technical success was achieved in 14 patients (93.3

Background:A rare complication in granulomatosis with polyangiitis is aneurysm formation with the risk of rupture. It is estimated that aneurysm formation is caused by inflammatory vasculitic activity in the arterial wall. We present a case of haemobilia secondary to hepatic artery aneurysm rupture in a patient with granulomatosis with polyangiitis. Upon presentation in the emergency department with upper abdominal pain and jaundice, point-of-care ultrasound was interpreted as cholestasis with suspected sludge in the gallbladder and common bile duct. The in-hospital treatment comprised the accurate diagnosis by endoscopic ultrasound, aneurysm treatment in interventional angiology and biliary tree clearance in endoscopic retrograde cholangiography. Purpose:This case indicates haemobilia as a differential diagnosis for echogenic material in the biliary tree with cholestasis in point-of-care ultrasound and should raise awareness of visceral aneurysm formation in granulomatosis with polyangiitis.

Focal treatment has emerged as a precision-oriented alternative to whole-gland treatment approaches for localized prostate cancer. It aims to selectively destroy clinically significant tumor foci while preserving surrounding structures that are essential for urinary continence and sexual function. Irreversible electroporation (IRE) is a relatively new and increasingly investigated focal treatment modality. By delivering short high-voltage pulses, IRE creates permanent nanopores in cell membranes and induces cell death predominantly through non-thermal mechanisms.This theoretical advantage - tissue ablation with relative preservation of the collagen-rich extracellular matrix - has heightened interest in IRE, particularly for tumors located near sensitive structures such as the neurovascular bundles, the urethral sphincter complex, and the rectal wall.In this review, we outline key procedural and technical aspects and summarize the clinical evidence for IRE in localized prostate cancer. Data from both prospective and retrospective case series demonstrate encouraging early and intermediate-term oncologic outcomes, although patterns of recurrence and the need for retreatment vary between cohorts and depend on the respective follow-up protocols. Functional outcomes are consistently excellent: continence is preserved in the vast majority of patients, and potency preservation is often high, typically ranging from approximately 75 to 95% among men who were potent prior to treatment.Despite these promising findings, widespread adoption in routine clinical practice is limited by the lack of robust long-term endpoints and the absence of randomized comparisons with established standards such as radical prostatectomy, radiotherapy, or risk-adapted active surveillance. While prospective comparative studies are highly challenging as they require large sample sizes, long follow-up periods, and careful endpoint definition, they are essential to clarify the role of irreversible electroporation within treatment algorithms, optimize patient selection, standardize follow-up and salvage strategies, and ultimately confirm durable tumor control with a sustained functional benefit.

In recent years, cryoablation has emerged as a minimally invasive, nephron-sparing treatment option for localized renal cell carcinoma. While partial nephrectomy remains the reference standard, percutaneous image-guided cryoablation represents an appealing alternative for elderly and/or morbid patients, providing short recovery times and aiming to preserve renal function to the greatest extent possible.Technically, the procedure relies on cryoprobes (argon/liquid nitrogen) and employes two freeze-thaw cycles. A key advantage is the excellent visualization of the developing "ice ball" on CT or MRI, which allows for real-time assessment of the ablation zone. A pre-procedural percutaneous tumor biopsy is recommended to confirm histology and grade of malignancy.The available evidence is largely based on retrospective cohort and registry data. There is a lack of randomized long-term comparative studies. Overall, high rates of oncologic control have been reported, but there is a tendency towards a higher risk of local recurrence compared with partial nephrectomy, particularly in larger lesions. Standardized follow-up protocols and prospective data are essential to better define indications, refine combination techniques, and assess long-term outcomes.

To evaluate the safety and clinical effectiveness of transarterial embolization (TAE) using temporary embolic agents in patients with symptomatic hip osteoarthritis (OA) refractory to conservative treatment. This single-centre retrospective analysis included patients undergoing TAE between January 2023 and April 2025. Eligibility required ≥ 3 months of clinically and radiographically confirmed hip OA unresponsive to conservative therapy. Embolization was performed using rapidly resorbable gelatin microspheres or imipenem/cilastatin. Outcomes included technical success, adverse events, and patient-reported outcomes (numeric rating scale [NRS] pain; Hip Disability and Osteoarthritis Outcome Score [HOOS]) assessed at baseline and up to 12 months. Clinically meaningful improvement was defined using minimum clinically important difference (MCID) thresholds (≥ 2 points for NRS; ≥ 10 points for HOOS). Forty-one patients (median age 65 years) underwent TAE with a technical success rate of 97.5

BACKGROUND & AIMS:Perineural invasion (PNI) is a recognized marker of tumor aggressiveness in several malignancies, but its prevalence and prognostic significance in intrahepatic cholangiocarcinoma (ICC) remain uncertain. This systematic review and meta-analysis aimed to estimate the pooled prevalence of PNI and evaluate its association with overall survival (OS) in ICC. METHODS:Following PRISMA guidelines, PubMed, Web of Science, and the Cochrane Library were searched through August 2025. The PNI prevalence was pooled using a random-effects model. Where available, multivariable hazard ratios for OS were pooled using a random-effects meta-analysis. Heterogeneity was assessed and potential moderators were explored using meta-regression. Pairwise ecological correlations between PNI and other tumor features were analyzed using Pearson's correlation coefficient. RESULTS:We analyzed 61 studies including 15,502 patients. The pooled prevalence of PNI was 36.0% (95% CI 31.0-41.0%), with substantial heterogeneity (I2 = 98.5%). Meta-regression identified publication year and study size as independent moderators, with more recent and larger studies reporting lower PNI prevalence. PNI positively correlated with lymph node metastasis, lymphovascular invasion, and vascular invasion (all p <0.001), and inversely correlated with the proportion of mass-forming ICC (p = 0.025). Of 44 studies assessing OS, 23 were included in meta-analysis, demonstrating that PNI was associated with worse survival (hazard ratio 1.79, 95% CI 1.38-2.19, p <0.001). CONCLUSIONS:PNI occurs in approximately one-third of patients with ICC, is associated with poorer outcomes, and clusters with lymph node metastasis and vascular invasion, reflecting aggressive tumor biology. Despite the heterogeneity of the available data, its adverse prognostic impact is consistent. IMPACT AND IMPLICATIONS:Perineural invasion (PNI) is a proposed marker of tumor aggressiveness in intrahepatic cholangiocarcinoma (ICC); however, its prevalence and prognostic significance have remained uncertain, warranting systematic evaluation. This study provides the most comprehensive synthesis to date of PNI in ICC demonstrating that PNI occurs in approximately one-third of ICC cases and clusters with adverse pathological features, although its independent impact on survival remains debatable. These findings are relevant for clinicians and researchers involved in ICC management, as they suggest that PNI may contribute to more refined risk stratification, particularly in early-stage disease. In practice, PNI assessment could support clinical decision-making and patient counseling. However, future standardized and prospective studies are needed to clarify its prognostic value and potential role in guiding treatment strategies.

Purpose:Abdominal aortic aneurysm (AAA) is a progressive vascular disease associated with high morbidity and mortality. Translational imaging and interventional research are limited by the availability of standardized large-animal models. This exploratory study compared different endovascular and pharmacological strategies for AAA induction in swine and characterized associated morphological and inflammatory vessel wall changes. Materials and Methods:19 female German Landrace swine were enrolled, with 18 included in the final analysis (n = 3 per group). Animals were assigned to five intervention groups and one untreated control group. Interventions comprised combinations of mechanical aortic dilation, intra-aortic administration of collagenase (6,000 IU), elastase (500 IU), calcium chloride (CaCl2, 25%; group-specific dosing), and oral β-aminopropionitrile (BAPN; 0.05-0.15 mg/kg). Aortic diameter changes and molecular markers of inflammation and vascular remodeling were assessed. Given the limited group size, analyses were considered exploratory and hypothesis-generating. Results:Mechanical dilation combined with enzymatic and CaCl2 exposure resulted in the largest mean increase in aortic diameter (1.63 ± 0.25 cm vs. 0.61 ± 0.04 cm in controls). This group was associated with increased Galectin-3 expression (89.69 ± 7.02%). BAPN alone was associated with smaller aortic dilations (0.73 ± 0.06 cm) and marked reduction of vascular smooth muscle cell markers, including α-smooth muscle actin (23.50 ± 4.82%), consistent with active extracellular matrix remodeling. Conclusion:Within this exploratory large-animal setting, combined mechanical and enzymatic injury was associated with more pronounced structural remodeling compared to isolated approaches, whereas BAPN predominantly induces early vessel wall degeneration. The graded phenotypes observed across groups provide a comparative framework for future preclinical imaging-based and interventional AAA research. Key Points:· The porcine models enable comparative preclinical investigation of graded abdominal aortic aneurysm phenotypes.. · Combined mechanical dilation and enzymatic injury is associated with more pronounced structural remodeling in swine.. · Greater structural remodeling is accompanied by increased macrophage-associated inflammatory markers.. · Vascular smooth muscle cell markers are reduced in association with vessel wall degeneration.. Citation Format:· Ranner-Hafferl M-LHH, Mangarova DB, Heyl JL et al. Characterization of Aortic Degeneration and Inflammatory Profiles in Porcine Models of Abdominal Aortic Aneurysm. Rofo 2026; 10.1055/a-2854-8724.

Zusammenfassung In den letzten Jahren haben sich die technischen Voraussetzungen sowie die flächendeckende Verfügbarkeit endovaskulärer Notfallverfahren in der interventionellen Radiologie deutlich verbessert. Dies hat zu einem breiten Spektrum an Notfallindikationen geführt, bei denen die endovaskuläre Therapie heute zu den bevorzugten Behandlungsoptionen zählt. Parallel dazu ist ein interventioneller 24-Stunden-Bereitschaftsdienst aus dem klinischen Alltag nicht mehr wegzudenken. Was für das Fachgebiet eine äußerst positive Entwicklung darstellt, bringt den Routinebetrieb jedoch zunehmend an seine personellen und organisatorischen Grenzen. Dabei stellt sich die zentrale, zugleich aber auch sensible Frage, welche Notfallinterventionen tatsächlich in den Nachtstunden zwischen 22 Uhr und 7 Uhr durchgeführt werden müssen und bei welchen Eingriffen eine Verschiebung auf den Folgetag vertretbar ist. Im folgenden Artikel werden sechs Fallbeispiele mit ihren jeweiligen Verläufen vorgestellt, die unter besonderer Berücksichtigung der Notfallversorgung analysiert werden. Neben dem Ablauf und der technischen Umsetzung steht dabei insbesondere die Einschätzung der zeitlichen Dringlichkeit der Behandlung im Mittelpunkt der Diskussion.

Background This study aims to evaluate the effects of sublethal hyperthermia on tumor growth of residual tumors in an immune-competent mouse model of prostate cancer.Materials and Methods The study progressed through sequential experiments to assess the effects of incomplete thermal ablation, starting with in vitro tests of sublethal heat on Myc-CaP cell growth, followed by in vivo tumor growth studies on FVB mice (n = 84), proteomic analysis of residual tumors, immunohistochemical evaluation of markers of cellular and vascular proliferation as well as immune markers and Western blot analysis of cytokine and growth factor expression over time.Results During in vitro-testing cells demonstrated a substantial increase in luminescence over time, while the control group remained stable. In vivo iTA led to significantly enhanced tumor growth both at the ablation site and in distant, untreated tumors, with increased cell proliferation, microvascular density, and expression of pro-tumorigenic factors (IL-6, HGF, VEGF). Proteomic analysis revealed that iTA induced strong early responses in wound healing, immune activation, and extracellular matrix remodeling, with systemic effects also seen in contralateral tumors. Immunohistochemistry and Western blot confirmed these findings and showed elevated immune cell infiltration, particularly CD45+ and CD11b + myeloid cells, indicating that iTA triggers a pro-inflammatory and pro-growth tumor microenvironment locally and systemically.Conclusion iTA can trigger tissue responses that accelerate tumor progression both locally and at distant sites, underscoring the need for careful pretreatment risk assessment (tumor size, achievable margins, proximity to critical structures) and vigilant monitoring of both treated and untreated disease after ablation.

Abstract Background We assessed the safety and efficacy of computed tomography (CT)-guided high-dose-rate (HDR) brachytherapy in treating hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT). Methods From January 2010 to January 2022, 56 patients (median age 67.5 years) with HCC and PVTT underwent 64 procedures. PVTT was further classified according to the Japan liver cancer study group into VP1–VP4. Tumor response was evaluated by cross-sectional imaging 6 weeks after CT-guided HDR brachytherapy and every 3 months thereafter. Local tumor control (LTC), progression-free survival (PFS), and overall survival (OS) were assessed using Kaplan–Meier curves. The severity of procedure-related complications was classified according to the Society of Interventional Radiology guidelines. Results Patients were available for imaging evaluation for a median follow-up of 14.0 months. The median diameter of the largest lesion was 56 mm. Estimated median PFS, LTC, and OS were 7.0 (95% CI 5.0–13.0), 14.0 (95% CI 7.0–21.0), and 20.0 (95% CI 13.0–26.0) months respectively. Actuarial 1-, 2-, and 3-year OS rates were 66%, 41%, and 27%, respectively. Subclassified for VP1, VP2, VP3, and VP4 estimated OS was 38.0 (95% CI 9.0-Not-a-number), 21.5 (95% CI 15.0–25.0), 15.0 (95% CI 7.0–33.0), and 13.0 (95% CI 6.0–34.0) months, respectively. Considering the 64 procedures, we recorded no complications for 49 (76.6%), mild-to-moderate complications for 12 (18.8%), and major complications for 3 (4.7%). Conclusion CT-guided HDR brachytherapy was safe and effective for locoregional treatment in patients with advanced HCC due to PVTT, achieving long-lasting local tumor control. Relevance statement CT-guided HDR brachytherapy is an option to be considered for locoregional treatment of patients with advanced HCC due to PVTT. Key Points Evaluation of CT-guided high-dose-rate (HDR) brachytherapy in treating HCC patients with portal vein tumor thrombosis (PVTT). Median OS was 20.0 months ranging between 13.0 and 38.0 months. CT-guided HDR brachytherapy seems to be a safe and effective treatment option in HCC patients with PVTT. Graphical Abstract

Body composition analysis (BCA) is a recognized indicator of patient frailty. Apart from the established bioelectrical impedance analysis (BIA), computed tomography (CT)-derived BCA is being increasingly explored. The aim of this prospective study was to directly compare BCA obtained from BIA and CT. A total of 210 consecutive patients scheduled for CT, including a high proportion of cancer patients, were prospectively enrolled. Immediately prior to the CT scan, all patients underwent BIA. CT-based BCA was performed using a single-slice AI tool for automated detection and segmentation at the level of the third lumbar vertebra (L3). BIA-based parameters, body fat mass (BFMBIA) and skeletal muscle mass (SMMBIA), CT-based parameters, subcutaneous and visceral adipose tissue area (SATACT and VATACT) and total abdominal muscle area (TAMACT) were determined. Indices were calculated by normalizing the BIA and CT parameters to patient’s weight (body fat percentage (BFPBIA) and body fat index (BFICT)) or height (skeletal muscle index (SMIBIA) and lumbar skeletal muscle index (LSMICT)). Parameters representing fat, BFMBIA and SATACT + VATACT, and parameters representing muscle tissue, SMMBIA and TAMACT, showed strong correlations in female (fat: r = 0.95; muscle: r = 0.72; p < 0.001) and male (fat: r = 0.91; muscle: r = 0.71; p < 0.001) patients. Linear regression analysis was statistically significant (fat: R2 = 0.73 (female) and 0.74 (male); muscle: R2 = 0.56 (female) and 0.56 (male); p < 0.001), showing that BFICT and LSMICT allowed prediction of BFPBIA and SMIBIA for both sexes. CT-based BCA strongly correlates with BIA results and yields quantitative results for BFP and SMI comparable to the existing gold standard. Question CT-based body composition analysis (BCA) is moving more and more into clinical focus, but validation against established methods is lacking. Findings Fully automated CT-based BCA correlates very strongly with guideline-accepted bioelectrical impedance analysis (BIA). Clinical relevance BCA is currently moving further into clinical focus to improve assessment of patient frailty and individualize therapies accordingly. Comparability with established BIA strengthens the value of CT-based BCA and supports its translation into clinical routine.