Purpose: Intrathecal injection of nusinersen is an approved treatment of spinal muscular atrophy (SMA). CT-guided injection is a method of nusinersen administration in patients with severe scoliosis, in whom standard lumbar puncture is not feasible. The injections are repeated every 4 months for life, and accumulated radiation doses absorbed by the patient can increase the risk of cancer. In this study, we present the results of CT-guided intrathecal nusinersen injections with an ultra-low radiation dose protocol. Methods: Eighteen patients (15 adults and three children) in whom standard lumbar puncture was not feasible due to severe scoliosis or spinal stabilization were included in this retrospective study. The first 23 injections were performed with a standard radiation dose protocol and the next 42 injections with an ultra-low-dose protocol. The radiation doses, measured as total dose length product (DLP), were acquired and compared between the protocols. Results: Injections were successful in 100% of patients with both ultra-low-dose and standard protocols. The radiation dose, measured as DLP, was 111.2–1100.7 (Me = 248.1) mGy*cm for the standard protocol. For the ultra-low-dose protocol, the dose range was 5.0–54.4 (Me = 26.7) mGy*cm, which was significantly lower than with the standard protocol (p < 0.001, η² = 0.67). Conclusion: Radiation doses can be significantly decreased in the CT-guided injection of nusinersen. The proposed protocol allows for effective CT-guided intrathecal nusinersen administration in patients with SMA and severe scoliosis.

Objectives: The objectives of the study were to evaluate adrenal radiofrequency ablation (RFA) as a method of treatment in patients with severe adrenocorticotropic hormone (ACTH)-dependent Cushing syndrome, among whom bilateral adrenalectomy is not a suitable option. Material and Methods: Five patients with ACTH-dependent Cushing syndrome underwent RFA of both adrenal glands. Four of them presented with Cushing disease unsuccessfully treated with pituitary surgery and medical therapy, while one patient had ACTH-dependent Cushing syndrome due to pancreatic endocrine tumor with liver metastases. All patients were disqualified from adrenalectomy due to morbid obesity or lack of consent. Results: A technical success was obtained in all cases, with only one re-intervention necessitated by a cooling effect of the inferior vena cava. Despite pre-procedural adrenergic blockade, severe hypertension was noted during the procedure in three cases, this being treated immediately using direct-acting vasodilators. No complications occurred otherwise. In all cases, significant improvement of clinical symptoms was observed, as well as marked decreases in levels of serum cortisol, free urine cortisol, and dehydroepiandrosterone sulfate. Conclusion: Bilateral RFA under CT-guidance is technically feasible and clinical improvement can be achieved using the method. In patients disqualified from adrenal surgery, RFA might be considered as an alternative method of ACTH-dependent Cushing syndrome treatment.

Some liver tumors are not visible on ultrasound or non-enhanced computed tomography (NECT) which are the main modalities used in image-guided ablations. This is a report of magnetic resonance-guided implantation of a fiducial marker to tag a neuroendocrine tumor metastasis in a patient with renal insufficiency precluding the use of a contrast-enhanced CT during ablation. The marker was well visible on NECT which allowed for precise needle placement and complete ablation which was confirmed in 12-month follow-up.

Colorectal cancer is a prevalent malignancy, with colorectal liver metastases (CLM) being a common and challenging clinical issue. Traditionally, surgical resection was the only curative treatment; however, percutaneous ablation (radio­frequency, microwave, and irreversible electroporation) has emerged as a treatment option for select patients. Early trials demonstrated the efficacy of thermal ablation, leading to its inclusion in international guidelines. Currently, for small tumours, it is considered a viable alternative to resection. Recent studies demonstrate the non-inferiority of thermal ablation compared to resection in select cases and emphasize the importance of achieving an adequate ablation margin. Advancements in imaging techniques, ablative modalities, the use of image fusion, as well as abla­tion confirmation software, allow for a more patient-tailored approach. Additionally, tumour biology, including genetic mutations, influences both overall survival and local control, highlighting the need for personalised treatment strategies. As randomised trials continue to provide more data, the role of ablation in CLM management is evolving. This paper aims to provide a narrative review of factors predicting local control and overall survival in patients treated with ablation. Future research focusing on molecular markers, advanced imaging, and ablation verification techniques may further refine patient selection, and optimise treatment outcomes and follow-up imaging.

Purpose: Cryoablation is one of the methods of treating patients with renal cancer with curative intent. This procedure is not widely available in Poland due to the lack of reimbursement until April 2023. The purpose of this study is to present the results of the first experiences in cryoablation of renal cell carcinoma in Poland.Material and methods: Patients with renal cell carcinoma in T1a stage (up to 4 cm in diameter) were treated with percutaneous cryoablation between December 2020 and December 2023. All patients were disqualified from surgical treatment due to age, comorbidities, or history of nephrectomy. Diagnosis was confirmed by computed tomography (CT)-guided core needle biopsy that was performed 2-4 weeks before cryoablation.Results: Twenty-five patients underwent CT-guided cryoablation of T1a renal cancer. The mean age of the patients was 77 years (43-91 years). The mean diameter of lesions was 27 mm (15-40 mm). None of the patients presented with local or distant recurrence within the mean 12-months of follow-up period (100% progression-free survival). Urine leak treated with a stent was detected in one patient. Four patients died within the follow-up period, but none of the deaths was directly related to the procedure.Conclusions: Cryoablation is an effective and safe procedure and should be available to more patients in Poland.

Background/Objectives: To evaluate the prognostic value of easily obtainable biomarkers for patients undergoing percutaneous microwave ablation (MWA) for colorectal liver metastases (CLMs). Prior studies showed that simple biomarkers, such as the lymphocyte-to-monocyte ratio (LMR), albumin-to-globulin ratio (AGR), platelet-to-lymphocyte ratio (PLR), and neutrophil-to-lymphocyte ratio (NLR), as well as cancer-specific markers, like carcinoembryonic antigen (CEA), might have a prognostic role in various malignancies; however, none of these were assessed in patients undergoing MWA for CLMs. Methods: Based on the simple laboratory results, which were determined prior to the ablation, several biomarkers, including the LMR, AGR, PLR, and NLR, were calculated. The log-rank test’s optimal cutoff points for continuous variables were determined. Subsequently, univariable and multivariable Cox regression models were utilized to determine the association between various features and overall survival (OS). Results: This study included 57 CLM patients with a mean age of 63 ± 12.5 years at the time of ablation with a mean follow up of 30.9 months. The univariable model demonstrated that a high level of CEA (cutoff: 29.1 ng/mL; HR: 3.70) and a high LMR (cutoff: 5.32; HR: 4.05) were related to worse OS, whereas a high NLR (cutoff: 2.05; HR: 0.31) and primary left-sided colon cancer (HR: 0.36) were positive prognostic factors. The multivariable regression model confirmed these findings, with the exception of the LMR, which was no longer significantly associated with OS. Conclusions: This study demonstrates the feasibility of overall survival prediction and thus patient stratification based on easily obtainable biomarkers and clinicopathological features in CLM patients undergoing MWA.