Computed tomography (CT)-guided musculoskeletal interventions (MSK-CTg-IR) are integral to modern interventional radiology, offering precise anatomic visualization, reproducibility, and accuracy for complex osseous and deep soft tissue procedures. These include biopsies, spinal pain interventions, vertebral augmentation, cementoplasty, osteosynthesis, and thermal ablation. Outcomes rely not only on imaging but also on lesion characteristics, workflow, radiation optimization, technical strategy, and patient interaction. Many practical insights remain underreported. This expert framework bridges theory and real-world practice, emphasizing planning, technical nuances, anatomic challenges, and troubleshooting. Success depends on anticipating procedural difficulties and adapting techniques dynamically to ensure safety, efficacy, and optimal patient outcomes.

This article provides a practical overview of technical strategies for ultrasound-guided musculoskeletal interventions, focusing on optimization of procedural safety, accuracy, and reproducibility. Key aspects include probe selection, parameter management, operator and patient positioning, planning of needle trajectory, and techniques for improving needle visualization. Other adjunctive approaches such as hydrodissection and Doppler imaging are also discussed, together with common technical pitfalls and strategies to avoid them. Emphasis is placed on the integration of technical proficiency, ergonomic setup, and dynamic anatomic understanding to improve outcomes in musculoskeletal interventional ultrasound.

Fluoroscopy-guided and intravascular procedures are fundamental in the management of vertebral lesions, including hemangiomas, aneurysmal bone cysts, and hypervascular metastases. This article provides a practical overview of spinal vascular anatomy, embolization strategies, percutaneous adjuncts and anesthetic considerations. Emphasis is placed on superselective technique, embolic agents, risk mitigation, percutaneous treatment and integration of endovascular therapy into multimodal treatment pathways. Technical considerations and procedural steps to support safe and effective application in daily practice.

This article summarizes practical and evidence-based strategies for ultrasound-guided musculoskeletal interventions, highlighting technical aspects that influence procedural precision, safety, and therapeutic effectiveness. Topics covered include patient selection, informed consent, aseptic preparation, equipment setup, needle visualization, and technical considerations for different anatomic regions, including small joints, spine, sacroiliac joint, and calcific tendinopathy. The article also addresses common procedural pitfalls, complication management, and the role of rehabilitation after intervention. Particular attention is given to the integration of anatomic expertise, real-time sonographic guidance, and standardized procedural techniques to enhance reproducibility and minimize complications in everyday musculoskeletal interventional practice.

Ultrasound (US) has gained traction in musculoskeletal imaging. There are 2 strong points that have boosted the role of US: the possibility of performing dynamic explorations and of guiding interventional procedures. This article reviews the applications of musculoskeletal image-guided procedures in acute and chronic trauma, excluding those specifically related to sports medicine. Most of them are performed using US guidance. Finally, foreign bodies can also be removed using US. All these procedures are safe and highly effective, sometimes making surgery unnecessary. With minimal invasiveness, they shorten recovery time so patients can resume their normal activities, including work or even sports.

Interventional radiology (IR) procedures are becoming increasingly relevant in the management of musculoskeletal disorders due to their high precision and low invasiveness. However, specific considerations need to be made when applied to children and adolescents, especially in terms of anesthetic care and radioprotection. The aim of this article is to provide a description of the main IR procedures available for the treatment of benign and malignant bone tumors, septic arthritis, and rheumatic diseases in the pediatric population (including radiofrequency ablation, high-intensity focused ultrasound, intralesional injection of sclerosing agents or steroids, biopsies, and embolization), summarizing available evidence and outlining distinctive aspects.

Intervention is a main part of musculoskeletal radiology. Image guided biopsy is a major skill that each interventional radiologist should master. Interventional therapeutic procedures particularly ablations have been increasingly recognized as an essential therapeutic option for treatment of soft tissue tumors both benign and malignant. Ablation can be used on its own or in conjunction with other therapeutic options such as surgery, chemotherapy, or radiotherapy. In this article, we provide a practical approach to some of these interventional procedures with particular focus on tips that we find useful in our daily practice.

Substantial recent advances in percutaneous image-guided minimally invasive interventions provide a robust arsenal for radiologists in management of patients with bone tumors. Percutaneous minimally invasive thermal ablation, cementation with or without osseous reinforcement via implants, and osteosynthesis have been successfully used and progressively incorporated into the management paradigm of patients with bone tumors. The purpose of this article is to outline the recent advances in such interventions and the role of radiologists in managing patients with bone tumors in modern-era practice.

Metabolic bone diseases are diverse disorders marked by impaired bone turnover or mineralization, causing fragility and fractures. Interventional radiology (IR) plays a key role by offering minimally invasive treatments for pain relief, stabilization, and early mobilization. Vertebroplasty is effective for painful osteoporotic vertebral fractures without deformity, while kyphoplasty or expandable devices suit cases with collapse or kyphosis. In Kümmell's disease, targeted cement augmentation provides rapid improvement. Sacral insufficiency fractures can be safely treated with computed tomography-guided sacroplasty, enabling early ambulation. Complex sacral fractures may require combined fixation and sacroplasty. Overall, IR enhances outcomes and reduces complications in frail patients.

Regenerative techniques are a rapidly expanding frontier in the interventional treatment of musculoskeletal disorders, involving endogenous mechanisms and bioactive molecules to repair tissue and modulate inflammation. Despite extensive basic research, the evidence supporting clinical use is highly heterogeneous and limited by variability in cell sources, preparation protocols and patient selection, high risk of bias, small sample sizes, and short follow-up periods. This article presents a critical overview regarding viscosupplementation, prolotherapy, platelet-rich plasma, collagen, stem cell and bone marrow aspirate concentrate therapy for osteoarthritis, chronic low back pain, tendinopathies, ligament, muscle, meniscal, and bone lesions.

Interventional and image-guided procedures have become key elements in the diagnosis and management of rheumatologic diseases. The advanced use of imaging modalities has transformed clinical practice by allowing high accuracy and efficacy in both diagnostic and therapeutic settings. This comprehensive article provides an overview of current evidence for a wide range of procedures, including synovial and bone biopsies, targeted therapies such as corticosteroid and viscosupplementation injections, and advanced ablation techniques like radiofrequency ablation. It also explores the expanding field of regenerative medicine, with a focus on orthobiologic therapies such as platelet-rich plasma and mesenchymal stem cells.

Image-guided percutaneous procedures are increasingly important in managing sports-related overuse and degenerative injuries. Corticosteroid injections remain widely used to reduce inflammation in conditions such as tendinopathies, cartilage lesions, synovitis, joint impingement, and spinal degeneration. However, treatment is evolving toward regenerative approaches, including dry needling, prolotherapy, platelet-rich plasma, and orthobiologics, which promote tissue healing. Advances in imaging have expanded applications to more complex conditions, such as chronic muscle pain, bone marrow lesions, nerve entrapment, and low back pain. Overall, these minimally invasive, targeted techniques are transforming sports medicine, offering effective alternatives to surgery and improved recovery outcomes.

Orbital trauma is a common consequence of craniofacial injury with potential for permanent vision loss. Rapid, accurate imaging interpretation is essential for triage and surgical planning. Multidetector computed tomography is the primary modality, enabling detection of fracture patterns, globe injury, extraocular muscle entrapment, and vascular complications. This article offers a systematic approach to orbital trauma evaluation, emphasizing findings that require urgent intervention, such as globe rupture, retrobulbar hematoma, muscle entrapment with ischemia, and orbital apex involvement. Diagnostic pitfalls and indications for surgical consultation are also discussed.