Francesco Mariotti

Traditional evaluations of artificial intelligence (AI) systems in the dynamic, operator-dependent, and time-sensitive field of interventional radiology (IR), focusing solely on algorithmic performance, often fail to capture their real-world clinical impact. This narrative review aims to provide an overview of the current state of the art of AI integration in IR through human–AI interaction (HAI), while offering a critical perspective on their clinical integration, limitations, and future directions. A comprehensive survey of recent literature was performed, focusing on AI applications across procedural phases. The review emphasizes systems providing decision support, real-time procedural verification, and immersive interfaces (augmented and virtual reality), while critically evaluating determinants of effective clinical adoption. AI has shown preliminary potential to support operator performance in selected interventional radiology tasks, although most applications remain experimental, retrospective, or evaluated in phantom or preclinical settings. Potential benefits include structuring uncertainty in patient selection and procedural planning, supporting assessment of device positioning and treatment outcomes, and integrating AI-derived outputs into the operator’s spatial field through immersive technologies. The clinical utility of these systems appears to be influenced by human–AI interaction, with interpretability, workflow integration, and trust calibration representing key determinants of effective use beyond algorithmic accuracy alone. The potential value of AI in interventional radiology appears to derive from its integration into human decision-making rather than from standalone predictive performance alone. A human-centered, interaction-based model supports understanding current applications, address challenges, and guide the development of adaptive, real-time systems for dynamic procedural environments.

Background: Endovascular approach has emerged as the first-choice treatment of visceral artery aneurysms (VAAs). However, most published series include heterogeneous populations combining true aneurysms and pseudoaneurysms. Our single-center retrospective study aimed to evaluate a large and homogenous series of true VAAs treated endovascularly. Demographic, clinical and procedural details of patients with VAAs treated at our Interventional Radiology unit from January 2014 to January 2025 were collected in a dedicated database. Intraprocedural and perioperative outcomes included technical success, complications, mortality and need for reintervention. At long-term follow-up, overall survival, aneurysm-related complications, freedom from reintervention, and aneurysmal sac reperfusion were evaluated. Results: Ninety-four consecutive patients (41 men; median age: 67.3 years; range 29–98 years) with 97 VAAs were included in the study. VAAs had a median diameter of 2.93 cm (range 6–9.2 cm). Treatment strategies included sac packing in 45 VAAs, sandwich technique in 35, covered stent placement in 13, afferent artery occlusion in 5 and stent-assisted coiling in 4 cases. Technical success rate was 100% with no perioperative deaths. Perioperative major complication and reintervention rates were 5.2% and 2.1%, respectively. At a mean follow-up of 44.7 ± 28.9 months, overall survival, freedom from aneurysm-related complications, and freedom from reintervention were 89.4%, 92.8%, and 93.8%, respectively. Aneurysm sac reperfusion was observed in 8(8.2%) cases. No aneurysm-related deaths occurred. Conclusion: Endovascular approach is a safe and effective first-line option in patients with true VAAs, with notable results in terms of complication and freedom from reintervention rates and an excellent long-term overall survival. Graphical

Background: Visceral artery aneurysms (VAAs) are rare but potentially life-threatening vascular lesions often clinically silent until rupture. The widespread use of advanced imaging has increased incidental detection, highlighting the need for accurate, noninvasive diagnostic strategies. Dual-Energy Computed Tomography Angiography (DECTA) offers potential advantages over conventional CT across diagnostic and post-treatment settings; however, its role in VAAs remains incompletely defined. This narrative review summarizes current evidence on DECTA applications in VAAs, focusing on diagnosis, emergency evaluation, and post-treatment follow-up. Methods: A non-systematic literature search of PubMed and Embase focusing on English-language articles up to June 2025 was performed. The search included peer-reviewed original research articles, systematic reviews, and meta-analyses addressing dual-energy CT and spectral CT in vascular and aneurysmal imaging. Case reports without technical data and non-English articles were excluded. Results: In the diagnostic phase, DECTA enhances tissue differentiation through virtual monoenergetic images, iodine maps, and material decomposition reconstructions. In the post-treatment setting, DECTA supports assessment after endovascular procedures, including coil embolization or stent graft placement. In VAAs, these techniques may improve aneurysm delineation, reduce metal artifacts after endovascular treatment, enable accurate detection of endoleaks or residual perfusion, and support volumetric follow-up. Virtual Non-Contrast images may reduce radiation exposure without compromising diagnostic confidence. Conclusions: DECTA represents a versatile imaging modality with potential benefits across the diagnostic, emergency, and post-treatment phases of VAA management. Although many applications are extrapolated from aortic and peripheral vascular disease, emerging evidence supports its growing clinical relevance. Further dedicated studies are needed to define its role in VAA-specific decision-making and follow-up.