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A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Medical Imaging and Theranostics".

Deadline for manuscript submissions: 30 June 2026 | Viewed by 10389

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Dr. Francesco Giurazza

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Guest Editor

Azienda Ospedaliera di Rilievo Nazionale Antonio Cardarelli, Naples, Italy
Interests: embolization; radial; oncology; SIRT; ablation; TACE; venous; stenting
Special Issues, Collections and Topics in MDPI journals

Dr. Fabio Corvino

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Guest Editor

Interventional Radiology Department, AORN “A. Cardarelli”, 80131 Naples, Italy
Interests: vascular and interventional radiology; embolization; radial; oncology; SIRT; ablation; TACE; venous; stenting
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

This Special Issue aims to highlight novelties in the field of Interventional Radiology (IR), focusing on both vascular and extravascular techniques.

In recent years, significant progress has been made in IR, especially in embolization and oncological interventions, which are the primary focal points of this Special Issue.

The role of IR in embolization is growing day by day, both in emergency and elective scenarios. Embolization for bleeding is a part of everyday life for interventional radiologists working in hospitals with emergency departments. Modern technologies involving embolic agents and microcatheters facilitate the safe and effective treatment of a wide range of diseases (aneurysms, AVMs, prostatic hypertrophy, PCS, varicoceles, genicular arthrosis, etc.); in parallel, the radial artery diffusion approach has improved patient comfort and reduced recovery time.

In the field of interventional oncology, the data gathered over the last two decades have demonstrated the role of IR as the “fourth pillar” of oncology; indeed, ablation, chemoembolization, and radioembolization are the tools of choice for interventional radiologists, not forgetting the increasing number of biopsies facilitating more personalized diagnosis and therapy. Today, IR is an integral element in all multidisciplinary team meetings.

In this Special Issue, we welcome contributions on these topics and more in the field of Interventional Radiology.

Dr. Francesco Giurazza
Dr. Fabio Corvino
Guest Editors

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Keywords

embolization
radial
oncology
radioembolization
ablation
chemoembolization

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Published Papers (9 papers)

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Research

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12 pages, 2145 KB

Open AccessArticle

Clinical and Radiological Outcomes Comparison of Degradable Starch Microspheres TACE with Idarubicin vs. Epirubicin Protocol in Patients with HCC

by Francesco Giurazza, Pietro Roccatagliata, Claudio Carrubba, Fabio Corvino, Raffaella Tortora, Marco Guarracino, Mariafiorella Brangi, Carla Migliaccio, Federica Falaschi, Maria Cammarota and Raffaella Niola

Diagnostics 2026, 16(7), 1100; https://doi.org/10.3390/diagnostics16071100 - 5 Apr 2026

Viewed by 420

Abstract

Background/Objectives: Transarterial chemoembolization (TACE) is included in international guidelines for the treatment of hepatocellular carcinoma (HCC), but it is still not a standardized intervention in terms of vector and chemotherapy. This study aims to report on clinical and radiological outcomes of degradable starch microspheres TACE (DSM-TACE) with idarubicin and compare with DSM-TACE with an epirubicin protocol after a single session. Methods: This is a single-center retrospective study analyzing cirrhotic patients affected by HCC in early or intermediate stages. Primary objectives were to assess the safety and efficacy of a single DSM-TACE with 10 mg idarubicin in terms of adverse event (AE) occurrences evaluated via the CTCAE 5.0 system and mRECIST criteria with computed tomography (CT) at 3 months. The secondary purpose was to compare the procedural outcomes with those from patients treated with DSM-TACE with 50 mg epirubicin. Results: Thirty-seven patients were included, 19 treated with idarubicin (IDA group) and 18 with epirubicin (EPI group); demographic data and lesion characteristics were comparable. No major AE (grade ≥ 3) occurred overall. In the IDA group, the minor AE incidence was 52.7%: one patient presented with mild ascites, eight developed hyperbilirubinemia and one leucopenia. At the 3-month CT follow-up, mRECIST criteria reported an overall response rate (ORR) of 63.2% and a disease control rate (DCR) of 84.2%. No statistically significant differences were appreciable comparing both AE occurrence and mRECIST findings with the EPI group (50% minor AE, 77.8% ORR, 88.9% DCR). Conclusions: In this sample of cirrhotic patients with HCC, DSM-TACE with 10 mg idarubicin was safe and effective comparable to DSM-TACE with 50 mg epirubicin. Full article

(This article belongs to the Special Issue Advancements in Interventional Radiology Techniques in Vascular and Extravascular Diseases)

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12 pages, 1619 KB

Open AccessArticle

Real-World Outcomes of Immediate Femoral Sheath Removal After Emergency Embolization in the Age of Ultrasound-Guided Device-Assisted Vascular Closure

by Terrence Hui, Akshay Kohli, Ross Copping, Hannah Ireland, Shady Osman, Bryan Barry, Jules Catt and Glen Schlaphoff

Diagnostics 2026, 16(1), 40; https://doi.org/10.3390/diagnostics16010040 - 22 Dec 2025

Viewed by 799

Abstract

Background/Objectives: Emergency arterial embolization is a life-saving procedure typically performed via femoral access. This study evaluated the safety and efficacy of immediate femoral sheath removal following emergency embolization. Methods: A retrospective cohort study was conducted at a Level 1 trauma center (January 2022–May 2025). Adult patients undergoing emergency embolization with immediate sheath removal were included. Endpoints were reintervention (repeat embolization within 7 days) and access site complications. Multivariate logistic regression identified independent predictors of outcomes. Results: A total of 322 emergency embolization procedures in 299 patients were included. The most common indication was gastrointestinal hemorrhage (45.7%). Vascular closure devices (VCDs) were used in 92.5% of cases. The re-intervention rate was 4.0% (13/322). The overall access site complication rate was 6.2% (20/322), with a major complication rate of 0.9% (3/322). On univariate analysis, pre-procedural platelet level ≤ 80 × 10⁹/L (p = 0.034) and INR > 1.5 (p = 0.034) were significantly associated with an increased risk of complications. On multivariate analysis, pre-procedural platelets ≤ 80 × 10⁹/L was the strongest independent predictor of access site complications (OR 7.28, 95% CI 1.51–35.12; p = 0.013). Choice of vascular closure device was an independent predictor for both reintervention and complications (p < 0.05), likely reflecting bias. Conclusions: Immediate femoral sheath removal following emergency embolization is safe for most patients. However, thrombocytopenia is a significant risk factor for access site complications. A risk-stratified approach with consideration for delayed sheath removal is warranted for patients with platelet counts ≤ 80 × 10⁹/L. Full article

(This article belongs to the Special Issue Advancements in Interventional Radiology Techniques in Vascular and Extravascular Diseases)

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18 pages, 4746 KB

Open AccessArticle

Transjugular Intrahepatic Portosystemic Shunt for Portal Vein Thrombosis in Cirrhotic Patients: 18-Year Experience in a Tertiary Referral Hospital

by Sara Barranco Acosta, María Sagrario Lombardo Galera, Pedro Blas García Jurado, María Eugenia Pérez Montilla, Antonio Jesús Láinez Ramos-Bossini and Juan José Espejo Herrero

Diagnostics 2025, 15(22), 2878; https://doi.org/10.3390/diagnostics15222878 - 13 Nov 2025

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Abstract

Background: Transjugular intrahepatic portosystemic shunt (TIPS) has emerged as a feasible therapeutic option for cirrhotic patients with portal vein thrombosis (PVT). This study aimed to assess the long-term outcomes and factors associated with TIPS dysfunction in cirrhotic patients with PVT over an 18-year period in our institution. Methods: A retrospective study was conducted at Hospital Universitario Reina Sofía (Córdoba, Spain), including adult and pediatric cirrhotic patients with PVT who underwent TIPS between January 2006 and December 2024. Patient characteristics, procedural techniques, and clinical outcomes were evaluated. The primary outcomes were TIPS insertion success rate, primary patency, and dysfunction (stenosis or occlusion). Bivariate comparisons, logistic regression and receiver-operating characteristic (ROC) analyses were performed to identify potential predictors of TIPS dysfunction. Survival analyses using the Kaplan–Meier method and log-rank test, complemented by Cox regression, were also conducted. Results: A total of 36 patients (mean age, 44.8 ± 20.1 years old; 22.2% women; 19.4% children) were included, with a mean follow-up of 66.3 ± 45.9 months and nine deaths (one attributable to the procedure). The primary success rate of TIPS placement was 100%, and mean primary patency was 40.3 ± 40.2 months. TIPS dysfunction occurred in 30.3% of patients. Logistic regression identified age as the only significant predictor of TIPS dysfunction (OR = 0.949; 95%CI, 0.907–0.985, p = 0.011). ROC analysis demonstrated an AUC of 0.737 (95%CI, 0.547–0.927), with an optimal age cut-off of 21 (equivalent to 18 years; sensitivity = 91.3%, specificity = 50%). When age was dichotomized into adult versus pediatric groups, the OR was 0.095 (95%CI, 0.011–0.560), consistent with survival analyses (log-rank p = 0.007; HR = 4.85; 95%CI 1.36–16.88, p = 0.015). Conclusions: TIPS is an effective treatment for cirrhotic patients with PVT, achieving high technical success and long-term patency. However, it is not exempt from complications, including death, and potential dysfunction remains a concern, particularly in pediatric patients. Further prospective studies with larger cohorts are warranted to refine patient selection and optimize outcomes. Full article

(This article belongs to the Special Issue Advancements in Interventional Radiology Techniques in Vascular and Extravascular Diseases)

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11 pages, 3222 KB

Open AccessArticle

Cervical Ectopic Pregnancies—Imaging and Endovascular Treatment

by Maciej Szmygin, Bartosz Kłobuszewski, Karolina Nieoczym, Weronika Dymara-Konopka, Sławomir Woźniak, Hanna Szmygin, Łukasz Światłowski and Krzysztof Pyra

Diagnostics 2025, 15(15), 1956; https://doi.org/10.3390/diagnostics15151956 - 4 Aug 2025

Cited by 4 | Viewed by 1531

Abstract

Objective: Cervical pregnancy (CP) accounts for less than 1% of all ectopic pregnancies. The standard of management for CP is still under detailed investigation; however, among the known treatment methods, super-selective uterine artery embolization (UAE) and the use of methotrexate (MTX) have emerged as effective and minimally invasive options in recent years. Our aim is to present our center’s experience and provide available evidence evaluating the efficacy of UAE in the treatment of CP. Materials and Methods: This single-center and retrospective study evaluated the procedural and clinical outcomes of patients with CP who underwent endovascular uterine embolization with MTX between 2017 and 2024. Both procedural and clinical efficacy and safety, as well as the rate of complications and long-term outcomes, were noted. Results: A total of nine patients were diagnosed with CP (imaging examination included transvaginal ultrasound and/or magnetic resonance imaging) and referred for endovascular treatment. The mean age of the patients was 36.7 years, and the mean gestational age on admission was 9 weeks. In all cases, selective catheterization of supplying vessels and subsequent embolization with a mixture of methotrexate and gel sponge was carried out. The technical success rate was 100% with no complications. Follow-up ultrasound confirmed the disappearance of the flow signal around the intracervical gestational sac in all cases. Conclusions: In conclusion, this retrospective study demonstrated the procedural and clinical safety and efficacy of uterine artery embolization in patients with cervical pregnancy. This is why endovascular therapy should be proposed to these individuals and be included in treatment options discussed during multidisciplinary boards. Full article

(This article belongs to the Special Issue Advancements in Interventional Radiology Techniques in Vascular and Extravascular Diseases)

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11 pages, 874 KB

Open AccessArticle

Low Tidal Volume Ventilation in Percutaneous Liver Ablations: Preliminary Experience on 10 Patients

by Francesco Giurazza, Francesco Coletta, Antonio Tomasello, Fabio Corvino, Silvio Canciello, Claudio Carrubba, Vincenzo Schettini, Francesca Schettino, Romolo Villani and Raffaella Niola

Diagnostics 2025, 15(12), 1495; https://doi.org/10.3390/diagnostics15121495 - 12 Jun 2025

Viewed by 955

Abstract

Objectives: Low tidal volume ventilation (LTVV) is a ventilatory strategy with the advantages of minimizing diaphragm movements and reducing hypercapnia and barotrauma risks. This preliminary study aims to report on the safety and effectiveness of LTVV applied during percutaneous US-guided liver ablations of focal malignancies. Methods: Patients affected by focal liver malignancies treated with percutaneous microwaves ablation were retrospectively included in this single-center analysis. Arterial gas analysis was performed immediately before and after ablation to evaluate the arterial pH, partial pressure of carbon dioxide (pCO₂), partial pressure of oxygen (pO₂), and plasma lactate levels. The primary endpoint of this study was to evaluate the safety and efficacy of LTVV during percutaneous liver cancer ablation. The secondary endpoint was to assess the procedural technical success in terms of correct needle probe targeting without the need for repositioning. Results: Ten patients affected by a single liver lesion had been analyzed. The ASA score was three in all patients, with three patients also suffering from COPD. The procedural technical success was 100%: ablations were performed with a single liver puncture without the need for changing access or repositioning the needle. No variations in post-ablation arterial gas analysis requiring anesthesiological management remodulation occurred. Lactate levels remained stable and hemodynamic balance was preserved during all procedures. No switch to standard volume ventilation was required. Conclusions: In this preliminary study, LTVV was a safe and effective anesthesiological protocol in patients treated with percutaneous ablations of liver malignancies, offering an ideal balance between patient safety and percutaneous needle probe positioning precision. Larger prospective studies are needed to confirm these findings. Full article

(This article belongs to the Special Issue Advancements in Interventional Radiology Techniques in Vascular and Extravascular Diseases)

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10 pages, 801 KB

Open AccessArticle

Ultra-Long-Term CT Angiography Evaluation of Patients Treated with Covered Stents for Visceral Aneurysms: A Single Center Case Series

by Marcello Andrea Tipaldi, Nicolò Ubaldi, Edoardo Ronconi, Michela Ortenzi, Francesco Arbia, Gianluigi Orgera, Miltiadis Krokidis, Tommaso Rossi, Pasqualino Sirignano, Luigi Rizzo and Michele Rossi

Diagnostics 2025, 15(12), 1481; https://doi.org/10.3390/diagnostics15121481 - 11 Jun 2025

Cited by 1 | Viewed by 996

Abstract

Objective: Endovascular repair of visceral artery aneurysms (VAAs) and visceral artery pseudoaneurysms (VAPAs) using covered stent grafts is a novel technique that preserves efferent vessel patency and prevents end-organ ischemia; however, long-term results are lacking in the literature. This study aims to evaluate ultra-long-term outcomes (>5 years) using CT angiography (CTA) and technical aspects of covered stents in treating VAAs and VAPAs. Methods: A single-center retrospective study was conducted on patients with VAAs and VAPAs treated with stent grafts between 2004 and 2023. The study included an ultra-long-term follow-up using CTA. Stent graft patency, aneurysm characteristics, technical success, 30-day and long-term follow-up clinical success, and mortality were assessed. Results: Among 23 patients presenting with VAAs and VAPAs treated exclusively with covered stents implantation, 7 (mean age: 68 years, SD 14), including 5 with VAAs and 2 with VAPAs, met the inclusion criteria for the study. Six of the seven patients underwent elective procedures with no significant periprocedural complications. Both technical and 30-day clinical success rates were 100%. The mean follow-up period was 10 years (125 months SD 53). At the 5-year follow-up, 71% of stent grafts remained patent. No patient experienced aneurysm sac revascularization or rupture. Stent obstruction did not affect survival. Conclusions: This study demonstrates that endovascular covered stenting is a durable and effective treatment for VAAs and VAPAs, even in the ultra-long term, with a patency rate of 71% at a mean CTA follow-up of 125 months, the longest reported to date and no cases of sac revascularization. Stent thrombosis was significantly associated with VAPAs. Full article

(This article belongs to the Special Issue Advancements in Interventional Radiology Techniques in Vascular and Extravascular Diseases)

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11 pages, 906 KB

Open AccessArticle

Single Angio-Seal™ Device as a Simplified and Technically Feasible Alternative for Tract Closure in Percutaneous Portal Vein Access: A Retrospective Study

by Ismail Karluka and Mustafa Mazıcan

Diagnostics 2025, 15(10), 1266; https://doi.org/10.3390/diagnostics15101266 - 16 May 2025

Viewed by 1423

Abstract

Purpose: This study aimed to evaluate the efficacy and safety of the Angio-Seal™ VIP vascular closure device (VCD) in achieving hemostasis following percutaneous transhepatic portal venous interventions. Methods: This retrospective study evaluated 20 patients (mean age: 52.85 ± 16.18 years; 80% male) who underwent percutaneous transhepatic portal vein interventions followed by tract closure with the Angio-Seal™ device between January 2016 and September 2024. Procedural data, pre- and post-procedural hemoglobin and hematocrit levels, and complications were analyzed. Technical success was defined as the successful deployment of the device with immediate hemostasis and no evidence of bleeding on post-procedural imaging. Results: Technical success, as defined in this study, was achieved in all 20 procedures (100%). The mean hemoglobin level declined from 11.91 ± 2.01 g/dL to 11.09 ± 2.19 g/dL (p < 0.001), and the mean hematocrit level decreased from 36.18 ± 6.03% to 32.98 ± 5.80% (p = 0.001). A hemoglobin drop ≥2 g/dL occurred in two patients (10%) and a hematocrit drop ≥4% in six patients (30%); none were associated with imaging or clinical evidence of hemorrhage. No major complications were observed. Minor complications, including localized pain managed with analgesics, occurred in five patients (25%). Follow-up imaging confirmed the absence of hemoperitoneum or device-related failure. Conclusions: Angio-Seal™ is a technically feasible, safe, and effective option for tract closure following percutaneous transhepatic portal vein access. This single-device approach may offer a cost-effective alternative to traditional embolization techniques. However, more extensive prospective studies are required to validate these findings. Full article

(This article belongs to the Special Issue Advancements in Interventional Radiology Techniques in Vascular and Extravascular Diseases)

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Review

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25 pages, 1076 KB

Open AccessReview

Genicular Artery Embolization for Knee Osteoarthritis: An Interventional Radiology Perspective on Pathophysiology, Imaging Biomarkers and Procedural Strategy

by Alberto Rebonato, Mattia Ruschioni, Luigi Mancini, Luca Mulazzani, Eva Fraternali, Marco Baldini, Nicolò Baiocchi, Daniele Maiettini, Corrado Tagliati and Luca Memè

Diagnostics 2026, 16(9), 1325; https://doi.org/10.3390/diagnostics16091325 - 28 Apr 2026

Viewed by 139

Abstract

Genicular artery embolization (GAE) has emerged as a minimally invasive interventional radiology technique for the management of symptomatic knee osteoarthritis (OA), a highly prevalent condition associated with substantial functional impairment and socioeconomic burden. The rationale of GAE is based on superselective embolization of pathological periarticular neovascularization, aiming to modulate synovial inflammation, angiogenesis, and nociceptive signaling while preserving physiological joint perfusion. This narrative review provides an interventional radiology–oriented framework integrating pathophysiological mechanisms, imaging-based patient selection, and procedural strategy. Particular emphasis is placed on the vascular–inflammatory phenotype of OA, MRI-derived biomarkers of synovitis and hypervascularity, and technical aspects of embolization, including embolic agent selection and angiographic endpoints. A structured literature search was performed to identify relevant studies, including prospective trials and randomized controlled studies. Available evidence is critically discussed, with attention to clinical outcomes, safety profile, and current limitations. In addition, practical technical considerations and procedural pitfalls are summarized to provide a clinically applicable perspective. GAE represents a promising therapeutic option for selected patients with knee OA refractory to conservative management. However, further high-quality studies are required to define long-term durability, optimal patient selection, and standardized procedural strategies. Full article

(This article belongs to the Special Issue Advancements in Interventional Radiology Techniques in Vascular and Extravascular Diseases)

9 pages, 1417 KB

Open AccessReview

Pressure Gradient-Driven Embolization b-TACE for HCC: Technical and Diagnostic Step-by-Step Procedural Guide and Literature Review

by Bianca Rocco, David C. Madoff, Fabrizio Basilico, Elio Damato, Paolo Vetri, Valeria Panebianco, Carlo Catalano and Pierleone Lucatelli

Diagnostics 2025, 15(13), 1726; https://doi.org/10.3390/diagnostics15131726 - 7 Jul 2025

Cited by 1 | Viewed by 1674

Abstract

Background: Hepatocellular carcinoma (HCC) is one of the leading cause of cancer death worldwide. Transarterial therapies represent an important tool in the management of different clinical scenarios, from a patient with a single nodule to a patient with multinodular disease. Up to 30% of patients are diagnosed with intermediate-stage HCC, and transarterial chemoembolization (TACE) represents the mainstay of treatment. Overall survival in patients with HCC undergoing TACE is strongly influenced by obtaining a sustained complete response, which is strongly affected by the HCC’s dimension. Methods: Pressure gradient-driven embolization, achieved by employing a microballoon catheter in the balloon-occluded TACE (bTACE), represents the most novel innovation in the field of transarterial therapies in the last decade. In fact, bTACE, thanks to its ability to redistribute flow towards tumor territories, can allow higher chemotherapeutic drug concentrations, leading to better oncological performance, especially in patients in which standard TACE struggles to obtain a complete response. Conclusions: This technical and diagnostic intraprocedural step-by-step guide, discussed with a review of the existing literature, will enable readers to achieve an optimal procedure and to convey to their patients the full clinical benefits of these procedures. Full article

(This article belongs to the Special Issue Advancements in Interventional Radiology Techniques in Vascular and Extravascular Diseases)

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