To investigate the occurrence of pseudoprogression/transient enlargement in meningiomas after stereotactic radiotherapy (RT) and to evaluate recently proposed volumetric RANO meningioma criteria for response assessment in the context of RT. Sixty-nine meningiomas (benign: 90%, atypical: 10%) received stereotactic RT from January 2005–May 2018. A total of 468 MRI studies were segmented longitudinally during a median follow-up of 42.3 months. Best response and local control were evaluated according to recently proposed volumetric RANO criteria. Transient enlargement was defined as volumetric increase ≥20% followed by a subsequent regression ≥20%. The mean best volumetric response was −23% change from baseline (range, −86% to +19%). According to RANO, the best volumetric response was SD in 81% (56/69), MR in 13% (9/69) and PR in 6% (4/69). Transient enlargement occurred in only 6% (4/69) post RT but would have represented 60% (3/5) of cases with progressive disease if not accounted for. Transient enlargement was characterized by a mean maximum volumetric increase of +181% (range, +24% to +389 %) with all cases occurring in the first year post-RT (range, 4.1–10.3 months). Transient enlargement was significantly more frequent with SRS or hypofractionation than with conventional fractionation (25% vs. 2%, p = 0.015). Five-year volumetric control was 97.8% if transient enlargement was recognized but 92.9% if not accounted for. Transient enlargement/pseudoprogression in the first year following SRS and hypofractionated RT represents an important differential diagnosis, especially because of the high volumetric control achieved with stereotactic RT. Meningioma enlargement during subsequent post-RT follow-up and after conventional fractionation should raise suspicion for tumor progression.

The apparent diffusion coefficient (ADC) is a candidate marker of treatment response in osteoblastic metastases that are not evaluable by morphologic imaging. However, it is unclear whether the ADC meets the basic requirement for reliable treatment response evaluation, namely a low variance of repeated measurements in relation to the differences found between viable and nonviable metastases. The present study addresses this question by analyzing repeated in vivo ADC_median measurements of 65 osteoblastic metastases in nine patients, as well as phantom measurements. PSMA-PET served as a surrogate for bone metastasis viability. Measures quantifying repeatability were calculated and differences in mean ADC values according to PSMA-PET status were examined. The relative repeatability coefficient %RC of ADC_median measurements was 5.8% and 12.9% for phantom and in vivo measurements, respectively. ADC_median values of bone metastases ranged from $595\times {10}^{-6}{\mathrm{mm}}^2/\mathrm{s}$ to $2090\times {10}^{-6}{\mathrm{mm}}^2/\mathrm{s}$ with an average of 63% higher values in nonviable metastases compared with viable metastases (p < 0.001). ADC shows a small repeatability coefficient in relation to the difference in ADC values between viable and nonviable metastases. Therefore, ADC measurements fulfill the technical prerequisite for reliable treatment response evaluation in osteoblastic metastases.

Transjugular intrahepatic portosystemic shunt (TIPS) is an established treatment for complications of portal hypertension; yet the influence of anesthesia modality on procedural performance and hemodynamics remains insufficiently characterized. This retrospective single-center study compared radiation exposure, procedural parameters, and portal hemodynamics between procedures performed with and without general anesthesia (GA). A total of 84 patients were identified, of whom 62 were age- and sex-matched into two equal groups: group 1 (GA, n = 31) and group 2 (no GA, n = 31). Evaluated parameters included length of hospital stay, dose area product (DAP), fluoroscopy time (FT), contrast volume, number of digital subtraction angiography series, procedure duration, and pre- and post-TIPS measurements of portal venous pressure, central venous pressure (CVP), and portosystemic pressure gradient (PPG). Non-parametric statistical tests were applied. Patients in group 1 had significantly shorter postoperative hospital stay (median 6 days; interquartile range (IQR): 4–7) than those in group 2 (8 days; IQR 6–8; p = 0.006). Radiation dose was significantly lower in group 1, with a median DAP of 127.1 Gy*cm ² (IQR 64.6–201.8) compared to 325 Gy*cm ² (IQR 162.3–393.7; p = 0.02) in group 2. FT was also reduced under GA (12.2 minutes; IQR 9.6–15.9 vs. 16.0 minutes; IQR 11.5–25.9; p = 0.01), as was contrast volume (75 ml; IQR 60–100 vs. 90 mL; IQR 60–110; p = 0.01). PPG reduction was achieved in both groups, despite higher CVP under GA. These findings suggest that GA may facilitate more stable procedural conditions during TIPS, reducing radiation dose and contrast use without compromising hemodynamic effectiveness.

Acute mesenteric venous thrombosis (aMVT) is a rare but life-threatening form of mesenteric ischemia associated with 30-day mortality of 17–76% without timely therapy. Over the past decade, advances in endovascular technology have transformed the therapeutic landscape. This review comprehensively appraises current evidence on innovative interventional techniques in the management of aMVT, including catheter-directed thrombolysis (CDT), percutaneous mechanical thrombectomy (PMT), large-bore aspiration, transjugular intrahepatic portosystemic shunt (TIPS)-guided approaches, and combined endovascular strategies compared with systemic anticoagulation with regard to recanalization rates and complications in cirrhotic and non-cirrhotic patients. A systematic literature search was conducted across PubMed/MEDLINE and CENTRAL (January 2000 – March 2025). A total of 35 primary studies met inclusion criteria, including 34 (97%) retrospective studies and one (3%) randomized controlled trial. Endovascular therapy was associated with higher recanalization rates (53.8-100%) than systemic anticoagulation (39–85%). TIPS-assisted thrombectomy achieved 100% immediate recanalization and 97% one-year primary portal patency in a non-cirrhotic series, with a 1-year mortality of only 3%. Large-bore aspiration demonstrated 95% technical success and no major bleeding, expanding eligibility to patients with thrombolytic contraindications. In optimally managed interventional settings, there was no need for bowel resection, compared with 5.3–21% in systematic anticoagulation-managed cohorts. Current clinical practice guidelines universally assign interventional modalities to Class IIb/Level C recommendations, substantially lagging behind the clinical evidence. Emerging interventional strategies demonstrate promising recanalization rates with an acceptable complication profile in most studies. This may provide advantages over anticoagulation alone in carefully selected patients with aMVT, although available evidence remains heterogeneous and predominantly observational. An institutional decision tree reflecting current interdisciplinary clinical practice is presented as one illustrative approach to patient stratification and escalation. Future prospective and multicenter studies are required to determine the optimal time and type of endovascular interventions to improve future guideline recommendations in carefully defined patients at tertiary centers.