RPS 1009 - Advances in musculoskeletal and soft tissue interventions

Author Block: S. Zensen¹, F. Behr¹, M. Opitz¹, D. Bos¹, M. Holtkamp¹, L. Salhöfer¹, J. Haubold¹, M. Moche², B. M. Schaarschmidt¹; ¹Essen/DE, ²Leipzig/DE
Purpose: Image-guided bone biopsies are critical for the diagnosis of a wide range of bone lesions, yet there is limited large-scale data on the technical success, diagnostic yield, and safety of these procedures. This study aims to evaluate the efficacy and safety of image-guided bone biopsies using data from the German Society for Interventional Radiology and Minimally Invasive Therapy (DeGIR, Deutsche Gesellschaft für Interventionelle Radiologie und minimal-invasive Therapie) registry.
Methods or Background: In this retrospective observational study, 17,397 bone biopsies from 214 centers between 2018 and 2022 were analyzed. Technical success was defined as the visually successful placement of the biopsy needle within the target lesion. Complications were classified according to the Society of Interventional Radiology (SIR) guidelines.
Results or Findings: About one-third of biopsies were performed as outpatient procedures (34%,5,924/17,397). Most biopsies were conducted under local anesthesia (86.6%,15,072/17,397). CT-guidance was used in the majority (68.7%,11,952/17,397). The technical success rate was 98.9% (17,201/17,397), with histological representativeness of 93.2% (10,316/11,073). Outpatient biopsies had a slightly higher technical success rate (99.32%,5,884/5,924) than inpatient biopsies (98.63%,11,316/11,473), though histological representativeness was lower (91.06%,1,284/1,410 vs. 93.48%,9,031/9,661, p=0.001). The overall complication rate was low at 0.62% (108/17,397), with major complications in 23.1% (25/108) of cases. Patients with abnormal coagulation parameters had higher complication rates. Sub-/solid lesions had higher histological representativeness compared to necrotic-cystic lesions (94.01%,7,846/8,346 vs. 90.32%,1,558/1,725, p<0.0001).
Conclusion: Image-guided bone biopsies are highly effective and safe, even in outpatient settings. The data support their continued use as a minimally invasive diagnostic tool, with low complication rates and high diagnostic accuracy.
Limitations: This study is limited by the nature of registry data, which is subject to reporting biases and lacks external validation. Incomplete data from some centers also restricted the scope of certain analyses.
Funding for this study: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Ethical approval for this retrospective registry study was granted by the ethics committee of the University of Duisburg-Essen, Germany (22-10893-BO).

Author Block: N. Papalexis, G. Peta, S. Quarchioni, M. Di Carlo, L. Campanacci, M. Carta, M. Miceli, G. Facchini; Bologna/IT
Purpose: To evaluate the clinical and radiological effect of arterial embolization using N-butyl cyanoacrylate (NBCA) as palliation for bone metastases.
Methods or Background: This study analyzes the early results of a prospective study “EMBONEMET”, designed to prospectively evaluate the safety and efficacy of palliative arterial embolization for bone metastases. Thirty-three patients were enrolled from June 2023 to June 2024. The primary goal was pain control, measured in VAS score at 3, 6 and 12 months follow-up. The secondary goal was the size reduction of the lesion. Data on technical success were also collected. All embolization-related complications were evaluated according to the CIRSE classification system for complications.
Results or Findings: The average follow-up was 9 months (range 2 to 12 months). Baseline VAS scores averaged 5,3 (SD 3,19), decreasing to 3.56 (SD 3,1) at three months. Progressive reduction was observed at 6 and 12 months with scores of 3,52 (SD 3,33), and 2,8 (SD 2,7) respectively. Metastatic tumor size was reduced from a mean of 196.8 cm3 (range 39.5 to 486.4 cm3) pre-embolization to a mean of 179.4 cm3 (range 38.2 to 458.6 cm3) at the 6-month follow-up (p<0.05). Twenty-nine patients experienced post embolization-related pain, that resolved within 15 days. Three patients experienced sensory loss of the lower leg, paresthesia and pain in the femoral catheter access point.
Conclusion: The preliminary results are promising, suggesting that arterial embolization could be a safe and effective tool for pain management and disease control in metastatic bone disease.
Limitations: Small sample size, lack of control group
Funding for this study: None
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Prospective study approved by the local ethics committee of Emilia Romagna, Italy.

Author Block: A. Vanzulli, L. V. Sciacqua, L. Saggiante, T. Cascella, C. Colombo, E. Palassini, C. Morosi, S. Stacchiotti, A. Gronchi; Milan/IT
Purpose: To evaluate the safety and efficacy of percutaneous cryoablation for the treatment of extra-abdominal desmoid tumours (DT) progressing after active surveillance/first-line treatments or threatening to life/function/quality-of-life.
Methods or Background: We retrospectively evaluated baseline and post-treatment MR and CT imaging of 27 consecutive procedures performed at our Institution between May 2021 and July 2024.
Treatment response was assessed both with standard and modified (m-) RECIST 1.1 (employing also T2WI and DWI to define tumour viability), with the underlying premise that dimensional reduction alone does not adequately capture tissue viability and may incompletely depict responses to local treatments.
Three different timepoints were considered: approximately 40 days after treatment, 5-10 months after treatment and 11-16 months after treatment.
Results or Findings: The study cohort comprised 25 patients (21 females and 4 males; median age at treatment: 36 years; age range 13-59 years) affected by extra-abdominal treatment eligible for local ablative therapies.
Tumour locations included the head & neck (3), the thoracic wall (4), the abdominal wall (19) and the lower extremities (1), with an average maximum diameter of 81,2 mm (range 32-162,3 mm).
At approximately 40 days after treatment, mRECIST responses were: 2/19 (10,5%) Stable Disease (SD), 6/19 (31,6%) Partial Response (PR) and 11/19 (57,9%) Complete Response (CR).
At 5-10 months after treatment, mRECIST responses were: 9/18 (50%) SD, 2/18 (11,1%) PR and 7/18 (38,9%) CR.
At 11-16 months after treatment, mRECIST responses were: 6/16 (37,5%) SD, 4/16 (25%) PR and 6/16 (37,5%) CR.
At 11-16 months after treatment, standard RECIST responses were: 1/16 (6,3%) Progressive Disease (PD), 14/16 (87,5%) SD and 1/16 (6,3%) PR.
Conclusion: Percutaneous cryoablation represents a feasible treatment for extra-abdominal DT requiring treatment.
mRECIST 1.1 outperform standard RECIST1.1 in this clinical scenario.
Limitations: Retrospective
Funding for this study: Nothing to disclose
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: Not applicable

Author Block: B. Wang¹, K-W. Liang², H. Y. Lin²; ¹Tainan/TW, ²Taichung/TW
Purpose: To assess the efficacy of transarterial embolization (TAE) for adhesive capsulitis (AC) by evaluating clinical outcomes and changes in inflammatory status using magnetic resonance imaging (MRI).
Methods or Background: Patients diagnosed with AC, undergoing TAE, and with baseline and 3-month contrast-enhanced MRI evaluations, were included. MRI results were analyzed to assess periarticular capsule/ligament inflammation. Clinical assessments included pain scores using the Numeric Rating Scale (NRS) and functional scores using the Quick Disabilities of the Arm, Shoulder, and Hand (Quick DASH) questionnaire.
Results or Findings: Twenty-five patients with AC were included. Significant reductions in average NRS pain scores, and significant improvements in Quick DASH scores and ROM, including anterior flexion and abduction, were observed at 1, 3, and 6 months after TAE (all P < 0.001). MRI analyses revealed that TAE significantly decreased the grade of axillary recess (AR) capsule enhancement, the grade of rotator interval (RI) capsule T2 signal intensity, and the grade of RI capsule enhancement (all P  0.004).
Conclusion: TAE is a promising and safe therapeutic approach for AC, improving pain alleviation and functional recovery. The observed MRI findings suggest that the mechanism of TAE for AC may involve the reduction of inflammation and the elimination of angiogenesis.
Limitations: First, it was a single-arm study without a control group, meaning that clinical outcomes such as pain and functional scores were subjective and could be influenced by a placebo effect, necessitating cautious interpretation. Second, the study involved a relatively small number of patients. Third, the classification of hypersignality and enhancement intensity is arbitrary. Finally, different MRI machines with varying magnetic field strengths (1.5T and 3T) were used across patient examinations, introducing potential discrepancies in image interpretation.
Funding for this study: Nil
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Institutional Review Board of National Cheng Kung University Hospital: IRB No: B-ER-113-038

Author Block: K. Desalos, V. Sala, P-A. Ranc, L. J. Pavan, T. Vivarrat-Perrin, N. Amoretti; Nice/FR
Purpose: Segmental spinal instability after laminectomy and adjacent segment disease (ASD)
following arthrodesis often requires repeated surgical interventions, usually by complex surgical
procedures such as surgical arthrodesis under general anesthesia which can be often demanding in
patients with associated comorbidities. 
Trans-facetal fixation (TFF) under local anesthesia and CT guidance is a minimally invasive technique
which involves placement of percutaneous screws through the posterior facet joints to improve spinal
stability. 
Our retrospective study is aimed at evaluating the efficacy of pain reduction and improvement of daily
activities following CT guided TFF, in patients with symptoms related to focal instability secondary to
laminectomy or ASD.
Methods or Background: TFF were performed in 43 symptomatic patients with previous history of spinal surgery
(laminectomy and/or surgical arthrodesis) at Nice University Hospital between 2017 and 2024. The
pre and postoperative pain and disability levels were collected prospectively, using the visual analogue
scale (VAS) and the Oswestry Disability Index (ODI), at 6-months and 1-year. Long term outcomes
were assessed by telephone consultations.
Results or Findings: There was a mean decrease of VAS by 3.4 points at 6 months and by 3. 6 points at 1 year. Mean decrease of
ODI was 17.1 points at 6 months (47.7 +/- 13.4 versus 30.6 +/- 17.5, P=0.0009)). 
All the screws were satisfactorily positioned and the pain tolerance under local anesthesia was very
good. The average duration of the procedure was 46 minutes, without any significant complications.
Conclusion: TFF under CT guidance and local anesthesia resulted in a significant pain reduction and
improvement in daily activities, without any complications. 
TFF under CT guidance and local anesthesia is a safe and effective
alternative for symptomatic instability after previous surgical laminectomy and/or arthrodesis.
Limitations: Small cohort
Monocentric study
Funding for this study: CHU Nice
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: Not applicable

Author Block: F. N. N. Fleckenstein, B. Gebauer, F. Collettini; Berlin/DE
Purpose: Genicular artery embolization (GAE) is an innovative, minimally invasive therapy for patients with symptomatic knee osteoarthritis (OA) that is unresponsive to conservative treatments. Despite its potential, there is ongoing debate regarding the optimal embolic material for this procedure. This study assesses both the safety and efficacy of GAE using a novel, resorbable particle in treating symptomatic knee OA.
Methods or Background: A single-center study was conducted at our institution. Participants were aged between 40 and 90 years, all presenting with moderate to severe knee OA (Kellgren-Lawrence grades 2 to 4) and a history of failed conservative treatments. Baseline pain was measured using the visual analog scale (VAS), and symptoms were assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS). After femoral arterial access was achieved with a 4 Fr sheath, embolization was performed using Nexsphere-F particles (100-300 µm). Target vessels were identified through digital subtraction angiography, correlating with patients' pain locations. Adverse events and symptom improvements were evaluated at 6 weeks, 3 months, and 6 months following the procedure.
Results or Findings: 66 patients were enrolled, with a median age of 68y. OA severity was grade 2 (14%), 3 (44%), and 4 (42%). Technical success was 100%. Skin discoloration and mild knee pain, were reported in 9% of cases. No major complications occurred. At the 6-month, the KOOS quality-of-life index showed an 89% improvement, while VAS score indicated an 82% reduction in pain, median baseline 52/100 and 8/10, respectively.
Conclusion: This study demonstrates that using resorbable particles for GAE is both safe and effective in alleviating symptoms associated with OA that do not respond to conservative treatments.
Limitations: This is a single-center study without a control group, yet the size of the cohort is considerably large.
Funding for this study: No
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Ethics approved

Author Block: M. De Albert De Delas-Vigo, E. A. Vargas Meouchi, I. Benegas, A. Sallent, G. Duarri, Y. Lara Taranchenko, S. Roche, M. Veintemillas, J. Alonso; Barcelona/ES
Purpose: Describe the effects regarding pain relief and possible complications of hyaluronic acid (HA) injection in patients with ankle OA and OLT.
Methods or Background: Observational study of patients with ankle OA and OLT that had an ultrasound guided HA injection by the radiology department between January 1st 2020 and December 1st 2023 in our center and a minimum follow-up of 6 months. Patients' visual analog scale (VAS) at baseline, 3 months and 6 months after injection were recorded. Exclusion criteria were administration of another medication (except mepivacaine) or biological therapy and incomplete data collection during follow-up.
Results or Findings: 137 patients were referred to the radiology department for an ultrasound guided injection. Fifty-eight patients (63 ankles) that received HA injection for ankle OA and OLT were identified. Thirty-seven (42 ankles) were included. Baseline VAS score was 7.98 ± 1.37; 5.76 ± 2.14, and 6.64 ± 2.07 at 3 and 6 months post injection respectively (p<0.05). Patients reported a mean of 7.9 ± 7.81 months with some pain relief. Patients mean age was 59.6 (range 32-83) and mean follow-up was 18.8 ± 12.1 months. Eleven (26.2%) patients received a second HA injection and 7 (16.6%) underwent surgery during follow-up. No complications were recorded in this series.
Conclusion: HA injections is a safe treatment that may provide a temporary pain improvement in patients with ankle OA and OLT.
Limitations: Retrospective studio
Funding for this study: None
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: Prospective clinical study

Author Block: I. Ben Rejeb¹, J. Lavigne¹, S. Grange², J-B. Noel³, J-B. Pialat¹, N. Stacoffe¹; ¹Pierre-Bénite/FR, ²Saint-Étienne/FR, ³Lyon/FR
Purpose: Hydrodissection aims to reduce the risks associated with traditional open surgery by enabling minimally invasive access to the cervical spine. To evaluate the feasibility, effectiveness, and safety of using hydrodissection in percutaneous anterior cervical spine procedures.
Methods or Background: A retrospective analysis was conducted on 32 hydrodissection procedures (30 patients) performed between 2020 and 2024 in three medical centers. The patient cohort included individuals with advanced oncological conditions, benign tumors, trauma, and infections. The hydrodissection technique involved gradual injection of a mixture of normal saline and contrast medium under CT guidance, displacing the jugulo-carotid structures and creating a safe space for interventional procedures such as odontoid osteosynthesis, cementoplasty, biopsy, and thermoablation.
Results or Findings: The procedure was successfully completed in all 30 patients. The right-sided approach was predominantly used to avoid esophageal injury. The mean volume of dissection fluid used was around 250 ml, with continuous hydrodissection being essential to maintain the created space. A few patient with multiple level procedure reach to 500 ml. The extubation following the procedure was shortly delayed to avoid any compression risk. No perioperative or postoperative complications were reported.
Conclusion: The use of hydrodissection in anterior cervical spine procedures offers a safe and effective alternative to open surgery, particularly for high-risk patients. This technique minimizes neurovascular complications and ensures safe procedural access, with no recorded complications in this short serie.
Limitations: Further studies with larger cohorts are warranted to standardize the technique and confirm its safety and efficacy.
Funding for this study: None
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: Actually evaluated by a comittee to be approved for multiple center retrospective inclusion

Author Block: P-A. Ranc, N. Amoretti; Nice/FR
Purpose: To evaluate the efficacy percutaneous lumbar discectomy (PLD) under computed tomography (CT) guidance on pain, functional capacities and to estimate the speed of recovery by assessing the time before return to work.
Methods or Background: Patients treated by PLD were prospectively included between December 2019 and April 2021. Data collected consists in pain, duration of the symptoms, analgesia intakes, time of absence from work and the Oswestry Disability Index (ODI). Patients were followed-up during six months. Duration of hospitalization and time before return to work were reported. The Fisher test was used to compare nominal variables, the Kruskal-Wallis test for ordinal variables, and the Student test to compare quantitative continuous variables.
Results or Findings: A total of 87 patients were evaluated (median age, 56; interquartile range IQR, 42.5-66). The median ODI decreased from 44 (IQR, 33-53) to 7 (IQR, 2-16.5) at six months (p<0,001). The median visual analog scale (VAS) decreased from 8 (IQR, 8-9) to 2 (IQR, 0-3) within six months (p<0,001). In 96,5% of cases, patients were discharged on the day of the procedure, and 3,5% the following day. No severe adverse events were reported according to the society of interventional radiology (SIR) classification system. Out of the 57 patients at work, 50 were able to return to work during the follow-up with a median time of 8 days (IQR, 0-20).
Conclusion: Symptomatic lumbar disc herniations can be successfully treated by PLD, resulting in significant improvement of symptoms, functional capacities, and a fast return to work.
Limitations: The limitations of the study are the lack of a control group, so no real comparison among patients treated with surgical methods. Full follow-up was not obtained for 20 patients who had to be excluded from the analysis.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This study received approval from the institutional review board and reference on the clinicaltrials.gov database.

Author Block: L. J. Pavan, P-A. Ranc, T. Vivarrat-Perrin, K. Desalos, V. Kilani, E. Dien, N. Amoretti; Nice/FR
Purpose: To evaluate the immediate changing in spine imaging after positioning of a percutaneous interspinous process spacer (IPS) for symptomatic degenerative lumbar spinal stenosis (DLSS).
Methods or Background: All patients treated in our Centre from January 2021 to December 2023 with a new percutaneous IPS (Lobster®-Diametros Medical®) were retrospectively reviewed. Patients underwent this procedure for treating a symptomatic DLSS nonresponding to lumbar epidural injection.
All procedures were performed with combined CT-scan and fluoroscopy guidance under general anesthesia.
For each patient neural foramina area on sagittal plane, as well as zygapophyseal articular space on axial plane, were independently measured by two operators on the treated level of preoperative and postoperative CT-scans.
Results or Findings: Thirty-four consecutive patients were treated in the considered period, and all were retrospectively included in the study (mean age 79.2 ± 8.3 years [72-92], 27 males, 17 females).
Mean neural foramina area increased from 73 ± 19 to 93 ± 24 mm2 (+ 27%; p < 0.01).
Mean facet joint articular space increased from 2,2 ± 0,9 to 3,1 ± 1,1 mm (+ 40%; p < 0.01).
Inter-observer reliability was very good (Cronbach's alpha = 0.9).
No procedural complication was reported.
Conclusion: These imaging changes may explain the clinical effects of IPS. The widening of foramina may be related to a decrease pression on the middle column and the posterior portion of the intervertebral disk, with reduction of its protrusion. The widening of the zygapophyseal space is linked to a stretching of flavum ligaments with a consequent reduction of its bulging into the spinal canal. Both factors will play a major role in reducing clinical symptoms of DLSS.
Limitations: The retrospective design of the study.
Funding for this study: None
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: Not neede since observational and retrospective

Author Block: C. Wolfram, T. J. Vogl, K. Eichler, T. Gruber-Rouh; Frankfurt/DE
Purpose: There is critics that advancements in technology, particularly in cross-sectional imaging techniques such as computed tomography (CT) and magnetic resonance imaging (MRI) are better than conventional lymphography. The aim of the present study is to prove that a lipiodol-based conservative lymphography seals persistent lymphatic fistulas, providing a safe and effective alternative to conservative therapies and surgical interventions.
Methods or Background: A group of 39 patients who underwent lymphadenectomy resulting into inguinal lymphatic fistulas between 2003 and 2023 was selected. Participants were eligible if they had persistent lymphatic leakage after inguinal lymphadenectomy and were unresponsive to conservative treatment. Of these 39 patients, four could not be statistically evaluated in our retrospective study due to various technical problems. The remaining 35 patients were evaluated. Lipiodol lymphography was performed using transpedal lymphatic vessel cannulation. Data were collected through clinical records (RIS/PACS) and imaging follow-ups. Statistical analyses included the Wilcoxon–Mann–Whitney test using BiAS software. Success was defined as the complete occlusion of lymphatic leakage, and data on complications and additional interventions were collected.
Results or Findings: Therapeutic success was achieved in 22 patients (62.86%), with a mean resolution time of 7.13 days. For four patients there was no data on further course, while 13 required additional interventions (three surgical, six radiotherapy). Statistical analysis showed no significant correlation between the volume of administered iodized oil and therapeutic success (p = 0.51), nor lymphatic drainage volume (p = 0.69).
Conclusion: Our results highlight that conventional lymphography is a successful therapy. These findings could inform future studies aiming to refine patient selection criteria and optimize treatment protocols for complex lymphatic conditions.
Limitations: Not applicable.
Funding for this study: No funding was provided for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The ethics committee notification can be found under the number UID 2023-1444.