Lumbar back pain is one of the main causes of disability around the world. Most patients will complain of back pain at least once in their lifetime. The degenerative spine is considered the main cause and is extremely common in the elderly population. Consequently, treatment-related costs are a major burden to the healthcare system in developed and undeveloped countries. After the failure of conservative treatments or to avoid daily chronic drug intake, invasive treatments should be suggested. In a world where many patients reject surgery and prefer minimally invasive procedures, interventional radiology is pivotal in pain management and could represent a bridge between medical therapy and surgical treatment. We herein report the different image-guided procedures that can be used to manage degenerative spine-related low back pain. Particularly, we will focus on indications, different techniques, and treatment outcomes reported in the literature. This literature review focuses on the different minimally invasive percutaneous treatments currently available, underlining the central role of radiologists having the capability to use high-end imaging technology for diagnosis and subsequent treatment, allowing a global approach, reducing unnecessary surgeries and prolonged pain-reliever drug intake with their consequent related complications, improving patients’ quality of life, and reducing the economic burden.

Background: Chronic subdural hematoma (cSDH) is a common condition, particularly in individuals over 65 years of age. Its pathophysiology involves traumatic and inflammatory processes, culminating in hematoma formation. Although surgical drainage is the primary treatment of choice, its significant recurrence rates have prompted exploration of non-surgical options. This study evaluates the effectiveness of middle meningeal artery (MMA) embolization as an alternative or adjunctive treatment in asymptomatic or paucisymptomatic cSDH patients. Methods: This two-center retrospective study analyzed 93 patients treated with MMA embolization at two hospitals between 2020 and 2024. Patients exhibited either asymptomatic or mild symptomatic cSDH (Markwalder score 0 or 1), with hematoma thickness >10 mm. Pre- and post-treatment CT scans were compared to assess hematoma thickness, with follow-ups conducted at three months. Statistical analysis included ANCOVA and Mann–Whitney U tests for outcome evaluation. Results: Of the 93 patients, 44 underwent bilateral embolization, and 49 underwent unilateral embolization. Treatment reduced hematoma thickness by an average of 59% at three months follow-up. The trabecular subtype showed the greatest thickness reduction compared to other subtypes (p < 0.05). No significant differences were found between embolization materials. Only 3.2% of patients experienced technical complications, and three patients experienced rebleeding during follow-up. Conclusions: MMA embolization appears to be a safe and effective treatment for cSDH, providing a minimally invasive alternative to surgery. The technique shows promise in reducing hematoma size, especially in the trabecular subtype. Further research is needed to confirm these findings and establish their role in routine clinical practice.

Background: The aim of the present study was to evaluate the presence and the prognostic value of the radiological signs of microvascular invasion (MVI) of hepatocellular carcinoma (HCC) in patients with non-alcoholic fatty liver disease (NAFLD). Methods: Between January 2015 and December 2017, all patients (91 patients) with de novo HCC or HCC recurrence occurring at least 2 years after the last treatment in NAFLD (36 patients) or with hepatitis C virus (HCV) liver disease (55 patients) were included. Each HCC was treated with liver resection and transplantation to obtain the anatomopathological confirmation of MVI. All patients had at least one available computed tomography (CT) scan or magnetic resonance imaging (MRI) performed no more than one month prior to the treatment. The clinical data of each patient, tumor burden (diameter, margins, two-trait predictor of venous invasion (TTPVI), and peritumoral enhancement), the recurrence rate (RR) after a 1-year follow-up, and the time to recurrence (TTR) were collected. Results: The NAFLD–HCC nodules were larger as compared to HCV–HCC (51 mm vs. 36 mm, p = 0.004) and showed a higher prevalence of TTPVI (38.9 vs. 20.0%, p = 0.058). At multivariate analysis, nodule diameter >50 mm was found to be the only independent prognostic factor of TTPVI (hazard ratio: 21.3, 95% confidence interval: 4.2–107.7, p < 0.001), and the presence of TTPVI was confirmed to be the only independent prognostic factors of recurrence (hazard ratio: 2.349, 95% confidence interval: 1.369–4.032, p = 0.002). No correlations were found between TTR and irregular tumor margins or peritumoral enhancement. Conclusion: The NAFLD–HCC patients had larger tumors at diagnosis and showed a more frequent presence of radiological signs of MVI as compared to the HCV–HCC patients. The MVI was related to a more rapid recurrence after curative treatments, demonstrating the prognostic value of this radiological diagnosis.