Search Results (187)

Persistent Idiopathic Dentoalveolar Pain (PIDAP) is a persistent idiopathic toothache that frequently remains unresponsive to medical therapy. Precise targeting of the infraorbital nerve is essential for successful intervention, yet anatomical variability often limits the consistency of conventional radiofrequency ablation (RFA). This report describes a medial-to-lateral ultrasound- and computed tomography-guided approach, intended to align with the natural orientation of the infraorbital canal and potentially enhance electrode–nerve contact. A 48-year-old woman with refractory maxillary incisor pain underwent RFA after only transient benefit from a diagnostic nerve block. Ultrasound enabled accurate identification of the infraorbital foramen and confirmed the canal’s medial-to-lateral course, which then guided CT-assisted needle advancement into the orbitomaxillary segment. The patient experienced immediate analgesia. Pain reduction was maintained at the one-month follow-up. At the two-month assessment, although a mild symptom rebound was observed, no procedure-related complications were noted. This trajectory-based medial-to-lateral technique offers an anatomically grounded alternative for infraorbital nerve RFA and may represent a valuable option for refractory PIDAP. Full article

Low-back pain (LBP) is a leading cause of disability worldwide. When symptoms persist beyond 4–6 weeks, when red flags are suspected, or when precise patient selection for procedures is needed, imaging—primarily MRI (Magnetic Resonance Imaging)—becomes pivotal. The purpose is to provide a pragmatic, radiology-first roadmap that aligns an imaging phenotype with anatomical targets and appropriate image-guided interventions, integrating MRI-based phenotyping with image-guided interventions for subacute and chronic LBP. In this narrative review, we define operational MRI criteria to distinguish radicular from non-radicular phenotypes and to contextualize endplate/Modic and facet/sacroiliac degenerative changes. We then summarize selection and technique for major procedures: epidural and periradicular injections (including selective nerve root blocks), facet interventions with medial branch radiofrequency ablation (RFA), sacroiliac joint injections and lateral branch RFA, basivertebral nerve ablation (BVNA) for vertebrogenic pain, percutaneous disc decompression, minimally invasive lumbar decompression (MILD), and vertebral augmentation for painful fractures. For each target, we outline preferred and alternative guidance modalities (fluoroscopy, CT, or ultrasound), key safety checks, and realistic effect sizes and durability, emphasizing when to avoid low-value or poorly indicated procedures. This review proposes a phenotype-driven reporting template and a care-pathway table linking MRI patterns to diagnostic blocks and definitive image-guided treatments, with the aim of reducing cascade testing and therapeutic ambiguity. A standardized phenotype → target → tool approach can make MRI reports more actionable and help clinicians choose the right image-guided intervention for the right patient, improving outcomes while prioritizing safety and value. Full article

Minimally invasive ablative therapies have emerged as effective and safe alternate approach for the management of renal cell carcinoma (RCC), particularly in patients who are ineligible for surgery due to comorbidities or high operative risk. Techniques such as radiofrequency ablation (RFA), microwave ablation (MWA), cryoablation (CA), and high-intensity focused ultrasound (HIFU) offer kidney-sparing treatment with reduced morbidity. Current evidence suggests that for cT1a tumors (<4 cm), thermal ablation achieves technical success rates exceeding 95%, with local recurrence rates ranging from 1% to 9% and major complication rates generally below 5–7%. RFA is particularly suitable for small peripheral tumors, MWA enables rapid and deeper heating for larger or more vascular lesions, and CA provides precise control near critical structures. HIFU remains largely experimental with limited clinical applicability. Overall, these strategies demonstrate favorable oncological outcomes, emphasizing the importance of careful patient selection, multidisciplinary evaluation, and further studies to refine technique-specific indications and integration with systemic therapies. Full article

Background and Objectives: Osteoarthritis (OA) is a common cause of chronic pain. In refractory cases, cooled radiofrequency (CRF) of the genicular nerves is indicated. However, recent studies suggest that traditional targets may be insufficient, proposing the inclusion of the recurrent fibular nerve and the infrapatellar branch of the saphenous nerve. This study reports a prospective four-case series evaluating short-term outcomes of CRF at five revised targets in elderly Brazilian patients. Case Report: The study (CAAE No.: 55647722.5.0000.5142) included four patients (three women, one man; mean age 73.8 years) with moderate to severe refractory knee pain underwent diagnostic nerve block followed by ultrasound-guided CRF. After 30 days, three patients reported pain reduction, including two who experienced substantial improvement. One patient maintained severe pain. Improvements in physical performance, knee flexion, and extension were observed in patients who responded clinically, while individuals with coexisting myofascial pain showed limited functional gains. One patient experienced mild transient pruritus. In this prospective case series, CRF applied to five revised targets appeared feasible and well tolerated, with short-term improvement in pain and function in some patients. These preliminary descriptive findings support further investigation in larger controlled studies. Full article

Facial asymmetry significantly affects aesthetic appearance, essential functions such as mastication and speech, and psychological well-being. While traditional surgical interventions effectively address significant facial asymmetry, they are often associated with considerable morbidity, prolonged recovery periods, and potential complications. Consequently, interest in minimally invasive, non-surgical techniques has substantially increased, driven by advantages including reduced downtime, rapid recovery, and immediate aesthetic results. This narrative review critically evaluates contemporary non-surgical techniques for correcting facial asymmetry, focusing specifically on dermal fillers, collagen stimulators (polydioxanone powder), polydioxanone thread lifting, energy-based non-invasive devices (radiofrequency, ultrasound, and laser therapies), and extracorporeal shockwave therapy. The review is based on a structured literature search of PubMed/MEDLINE, Embase, and Google Scholar up to October 2025, focusing on human clinical studies and review articles on non-surgical correction of facial asymmetry and related facial contouring. We provide a detailed analysis of each treatment modality’s underlying mechanisms, clinical efficacy, advantages, limitations, and safety profiles. Current evidence suggests that these non-surgical methods effectively enhance facial symmetry by offering immediate visible improvements and progressive enhancements through natural collagen regeneration, thereby significantly improving patient satisfaction and overall quality of life. Clinicians are encouraged to incorporate these versatile, minimally invasive interventions into clinical practice, carefully tailoring treatments according to individual patient characteristics and specific aesthetic goals. Further research should aim to refine existing treatment protocols, evaluate long-term efficacy and safety, and establish standardized guidelines to optimize outcomes in facial asymmetry correction. Full article

Artificial intelligence (AI) is increasingly shaping interventional oncology, with growing interest in its application across thermal ablation modalities such as radiofrequency ablation (RFA), cryoablation, high-intensity focused ultrasound (HIFU), and microwave ablation (MWA). This review characterises the current landscape of AI-enhanced thermal ablation, with particular emphasis on emerging opportunities within MWA technologies. We examine how AI-driven methods—convolutional neural networks, radiomics, and reinforcement learning—are being applied to optimise patient selection, automate image segmentation, predict treatment response, and support real-time procedural guidance. Comparative insights are provided across ablation modalities to contextualise the unique challenges and opportunities presented by microwave systems. Emphasis is placed on integrating AI into clinical workflows, ensuring safety, improving consistency, and advancing personalised therapy. Tables summarising AI methods and applications, a conceptual workflow figure, and a research gap analysis for MWA are included to guide future work. While existing applications remain largely investigational, the convergence of AI with advanced imaging and energy delivery holds significant promise for precision oncology. We conclude with a roadmap for research and clinical translation, highlighting the need for prospective validation, regulatory clarity, and interdisciplinary collaboration to support the adoption of AI-enabled thermal ablation into routine practice. Full article

(1) Background: Transvaginal RFA is a minimally invasive treatment for myomas in women opting for uterus preservation. The present study aimed to evaluate the efficacy and safety of transvaginal RFA to treat myomas, reduce symptoms, decrease myoma volume, and identify prognostic factors for predicting treatment response. (2) Methods: The study group included 45 women treated for uterine fibroids at the Gynecological and Obstetrics Clinical Hospital in Poznań. From 1 July 2024 to 31 March 2025, a total of 45 transvaginal radiofrequency ablation (TV-RFA) procedures were performed. (3) Results: Ultrasound findings revealed that fibroid dimensions and volume significantly decreased at 1-month follow-up compared to those at pre-procedure (88.7 ± 116.3 vs. 64.6 ± 82.6 cm³; p = 0.003). Ultrasound findings demonstrated that fibroid depth (4.8 ± 2.1 vs. 4.1 ± 2.2; p = 0.01) and fibroid volume (88.7 ± 116.3 vs. 82.4 ± 93.9 cm³; p = 0.02) were significantly decreased at 3-month follow-up compared to their pre-procedure values. Menstrual bleeding duration showed significant differences between the pre-procedure state and 1-month follow-up (N = 23; T = 2; Z = 4.14; p < 0.001) and 3-month follow-up (N = 8; T = 1; Z = 2.38; p = 0.017), with a significant reduction after the RFA procedure. Significant differences were observed in bleeding severity at pre-procedure and at 1-month follow-up (N = 22; T = 11.5; Z = 3.73; p < 0.001); however, no significant differences in bleeding severity were noted at the 3-month follow-up (N = 7; T = 4; Z = 1.69; p = 0.09). These results should be interpreted cautiously due to the small number of patients with complete 3-month follow-up. (4) Conclusions: Transvaginal radiofrequency ablation is an effective, precise, and safe minimally invasive approach for treating uterine fibroids. These preliminary findings are promising but require confirmation in larger cohorts with longer follow-up. Full article

Breast cancer remains the most commonly diagnosed malignancy and a leading cause of cancer-related mortality among women worldwide. Neoadjuvant chemotherapy (NAC) is increasingly used, particularly in aggressive subtypes such as HER2-positive and triple-negative breast cancer, where achieving a pathological complete response (pCR) is strongly associated with improved outcomes. Early and accurate assessment of therapeutic response is therefore essential to enable timely treatment adaptation. Conventional imaging methods—including magnetic resonance imaging (MRI), computed tomography (CT), mammography, and B-mode ultrasound—mainly detect macroscopic tumor shrinkage and often lagging behind biological alterations, as they rely primarily on size-based assessment. Quantitative ultrasound (QUS) is an emerging, non-invasive technique that analyzes raw radiofrequency (RF) ultrasound data to extract spectral, scattering, and attenuation parameters, allowing detailed characterization of tumor microstructure. When combined with parametric mapping, texture analysis, and advanced radiomic or deep learning approaches, QUS can capture subtle tissue alterations at an early stage of therapy and help predict pathological response before conventional imaging detects morphologic change. Integration with molecular and clinical data further enhances predictive performance, enabling adaptive and personalized treatment strategies. This narrative review summarizes current evidence on the clinical utility of QUS in monitoring NAC response in breast cancer, outlines the methodological foundations of this technology, and discusses key challenges to its broader implementation—particularly the need for standardized acquisition and processing protocols, robust interpretive algorithms and large, prospective, multicenter validations to confirm its impact on clinical decision-making and patient outcomes, and to accelerate its translation into precision oncology practice. Full article

Cancer immunotherapy has redefined oncology’s goals, aiming for durable systemic immunity rather than mere cytoreduction. However, many solid tumors remain refractory due to immunosuppressive microenvironments and antigenic heterogeneity. Local tumor ablation techniques—including radiofrequency ablation (RFA), microwave ablation (MWA), cryoablation, irreversible electroporation (IRE), and high-intensity focused ultrasound (HIFU)—are being re-evaluated beyond their historic cytoreductive role. This comprehensive review synthesizes the paradigm of tumor ablation as an in situ vaccination strategy, a concept that leverages the tumor itself as a source of antigens and the ablation process to generate endogenous adjuvants. We detail the mechanistic underpinnings, highlighting how ablation induces immunogenic cell death (ICD), releasing damage-associated molecular patterns (DAMPs) such as calreticulin, ATP, HMGB1, and cytosolic DNA. These signals activate innate immunity via pathways like cGAS-STING, promote dendritic cell maturation, and facilitate epitope spreading. We critically examine the determinants of efficacy, including the critical impact of ablation modality on the “DAMP signature,” the necessity of complete ablation, and the pivotal role of the host’s immune contexture. Furthermore, we explore the induction of tertiary lymphoid structures (TLS) as a key anatomical site for sustained immune priming. Translational strategies are extensively discussed, focusing on optimizing procedural techniques, rationally combining ablation with immune checkpoint inhibitors (ICIs) and innate immune agonists, and developing a robust biomarker framework. By adopting the core principles of vaccinology—meticulous attention to antigen, adjuvant, route, and schedule—ablation can be engineered into a reproducible platform for systemic immunotherapy. This review concludes by addressing current limitations and outlining a roadmap for clinical translation, positioning interventional oncology as a central discipline in the future of immuno-oncology. Full article

Thyroid nodules, prevalent in 2% to 65% of the general population depending on diagnostic methodology, represent a significant clinical concern despite a low malignancy rate, typically 1% to 5%. A substantial proportion of thyroid cancers are small, indolent lesions, allowing for conservative management with favorable prognoses. Nodule detection commonly occurs via palpation, clinical examination, or incidental radiological findings. Established risk factors include advanced age, female gender, obesity, metabolic syndrome, and estrogen dominance. Despite conservative management potential, a considerable number of thyroid nodules in Europe are unnecessarily referred for surgery, incurring unfavorable risk-to-benefit ratios and increased costs. Minimally invasive techniques (MITs), encompassing ethanol and thermal ablation modalities (e.g., laser, radiofrequency, microwave), offer outpatient, nonsurgical management for symptomatic or cosmetically concerning thyroid lesions. These procedures, performed under ultrasound guidance without general anesthesia, are associated with low complication rates. MITs effectively achieve substantial and sustained nodule volume reduction (57–77% at 5 years), correlating with improved local symptoms. Thermal ablation (TA) is particularly favored for solid thyroid lesions due to its precise and predictable tissue destruction. Optimal TA balances near-complete nodule eradication to prevent recurrence with careful preservation of adjacent anatomical structures to minimize complications. Radiofrequency ablation (RFA) is widely adopted, while microwave ablation (MWA) presents a promising alternative addressing RFA limitations. Percutaneous laser ablation (LA), an early image-guided thyroid ablation technique, remains a viable option for benign, hyperfunctioning, and malignant thyroid pathologies. This review comprehensively evaluates RFA, MWA, and LA for thyroid nodule treatment, assessing current evidence regarding their efficacy, safety, comparative outcomes, side effects, and outlining future research directions. Full article

Background and Objectives: Chronic migraines are a disabling neurological disorder with limited response to preventive pharmacological treatments. Greater occipital nerve (GON)-targeted radiofrequency (RF) procedures have emerged as promising interventions, yet long-term comparative data between pulsed RF (PRF) and continuous-lesion RF (LesionRF) remain scarce. This study evaluated the 12-month efficacy and safety of PRF versus LesionRF. Materials and Methods: A single-center cohort of 211 patients with chronic migraine diagnosed by ICHD-3 criteria (PRF = 107; LesionRF = 104) was analyzed. All patients had a positive diagnostic block and ≥12 months of follow-up. Interventions were performed under ultrasound guidance with standardized protocols (PRF: 42 °C, 4 min, 45 V; LesionRF: 80 °C, 90 s). The primary outcome was a change in monthly migraine days (MMD), while secondary outcomes included responder rates (≥50% MMD reduction), pain intensity (VAS), functional outcomes (HIT-6, MIDAS), quality of life (SF-36, EQ-5D), medication use, retreatment, and complications. Results: Both groups improved, but LesionRF showed greater benefit. At 12 months, LesionRF achieved a larger MMD reduction (−4.8 days vs. PRF, p < 0.001), higher responder rates (83% vs. 65%, p = 0.01), and greater VAS decreases (−1.6, p < 0.001). Functional and quality-of-life scores improved more with LesionRF, with MIDAS reductions surpassing MCID and responder rates meeting PASS. Retreatment was less frequent with LesionRF (8% vs. 19%; HR 2.15, p = 0.037), and two LesionRF patients (1.9%) developed hematomas that resolved conservatively. Conclusions: Compared with PRF, LesionRF provided more sustained and clinically meaningful benefits for chronic migraines. Both approaches appeared to be safe, though confirmation in larger randomized trials is warranted. Full article

Background/Objectives: Adenomyosis is increasingly being identified in women of childbearing age as a cause of infertility and adverse pregnancy outcomes. As hysterectomies are not suitable for fertile women, conservative surgical management has become a promising solution. We aimed to synthesize current evidence on conservative uterus-sparing surgical techniques for adenomyosis, focusing on implications for infertility treatment and pregnancy outcomes. Methods: A search of PubMed, Google Scholar, and Europe PMC from 2022 to July 2025 was conducted using combinations of the words “adenomyosis,” “fertility,” “infertility,” “pregnancy outcomes,” “adenomyomectomy,” and “uterine-sparing surgery.” Sixteen high-relevance studies were chosen that included reproductive-aged women who had conservative surgery for adenomyosis. Results: Excisional techniques such as adenomyomectomy yield pregnancy rates of >50% and live birth rates of up to 70% in focal disease, with less success in diffuse disease. Non-excisional approaches—high-intensity focused ultrasound (HIFU), radiofrequency ablation (RFA), and uterine artery embolization (UAE)—yield equivalent pregnancy (40–53%) and live birth (35–74%) rates in selected patients, with fewer surgical complications. Adjunctive hormonal therapy, particularly GnRH agonists, appears to improve outcomes. Risks include placenta accreta spectrum disorders and uterine rupture (≤6%), especially in diffuse adenomyosis. The type of lesion, location, and junctional zone thickness are strong predictors of fertility outcomes. Conclusions: Conservative surgery can augment fertility in appropriately chosen women with adenomyosis, with removal being the preferred treatment for focal disease and non-removal techniques offering encouraging alternatives in mild or intracorporeal disease. The addition of adjunct hormonal therapy and standardized patient selection criteria will optimize results. The lack of European professional society guidelines underscores the need for harmonized protocols in order to standardize the diagnosis, surgery, and reporting of results. Full article

Neuropathic pain presents a persistent therapeutic challenge, arising from diverse etiologies such as trigeminal neuralgia, postherpetic neuralgia, post-amputation pain, painful polyneuropathy, peripheral nerve injury pain, and painful radiculopathy. Given the limitations and side effects associated with pharmacologic treatments, interest in interventional therapies has surged. Herein, ultrasound guidance provides real-time, radiation-free visualization that enhances procedural accuracy and safety. This narrative review synthesizes current evidence on ultrasound-guided techniques—including nerve blocks, pulsed radiofrequency, hydrodissection, and peripheral nerve stimulation—in the management of neuropathic pain. These minimally invasive approaches demonstrate potential in providing significant and durable pain relief, enhancing functional outcomes, and reducing reliance on systemic medications. Notably, much of the existing literature comprises small-scale or observational studies and larger randomized controlled trials are therefore essential to confirm efficacy, define optimal treatment parameters, and inform clinical guidelines for broader adoption. Full article

Pulsed radiofrequency (PRF) applied to the dorsal root ganglion (DRG) is commonly performed to manage lumbar radicular pain in human patients. Radiculopathy affecting the seventh lumbar spinal nerve has been identified as key predictor of lumbosacral pain in dogs, yet no published technique exists for placing a PRF electrode adjacent to its DRG to deliver PRF treatment. We describe a novel approach in canine cadavers, integrating ultrasound guidance to locate relevant landmarks and confirm cannula placement under fluoroscopy. Black Indian ink was used to create a localised tissue mark at the tip of a radiofrequency cannula, and subsequent cryosections were performed to measure the distance between the mark and the DRG, revealing a distance of 1.96 ± 1.07 mm. Because this was a cadaveric model, no conclusions can be drawn regarding clinical efficacy or safety in live animals. Nonetheless, these results demonstrate the feasibility of precise electrode positioning using combined imaging in dogs. Future research should explore whether PRF delivered through this approach can indeed alleviate lumbosacral radicular pain in dogs, as well as establish optimal electrode-to-nerve distances and potential safety considerations. Ultimately, this technique could broaden veterinary interventions for chronic spinal pain, improving the quality of life in affected dogs. Full article

Objectives: The FibroScan–aspartate transaminase (AST) score (FAST score) is a hybrid biomarker combining ultrasound and blood test data for identifying nonalcoholic steatohepatitis (NASH). This study aimed to assess the feasibility of using quantitative ultrasound (QUS) biomarkers related to hepatic steatosis for NASH detection and to compare their diagnostic performance with the FAST score. Methods: A total of 137 participants, comprising 71 individuals with NASH and 66 with non-NASH (including 49 normal controls), underwent FibroScan and ultrasound exams. QUS imaging features (Nakagami parameter m, homodyned-K parameter μ, entropy H, and attenuation coefficient α) were extracted from backscattered radiofrequency data. A weighted QUS parameter based on m, μ, H, and α was derived via linear discriminant analysis. NASH was diagnosed based on liver biopsy findings using the nonalcoholic fatty liver disease activity score (NAS). Diagnostic performance was evaluated using the area under the receiver operating characteristic curve (AUROC) and compared with the FAST score using the DeLong test. Separation metrics, including the complement of overlap coefficient, Bhattacharyya distance, Kullback–Leibler divergence, and silhouette score, were used to assess inter-group separability. Results: All QUS parameters were significantly elevated in NASH patients (p < 0.05). AUROC values for individual QUS features ranged from 0.82 to 0.91, with the weighted QUS parameter achieving 0.91. The FAST score had the highest AUROC (0.96), though differences with the weighted QUS and homodyned-K parameters were not statistically significant (p > 0.05). Separation metrics ranked the FAST score highest, closely followed by the weighted QUS parameter. Conclusions: QUS biomarkers can be repurposed for NASH detection, with the weighted QUS parameter offering diagnostic accuracy comparable to the FAST score and serving as a promising, blood-free alternative. Full article