Background <p>Aneurysmal bone cysts (ABCs) are benign vascular lesions commonly affecting the pediatric population.</p> Objective <p>To assess magnetic resonance imaging (MRI) features of ABCs after percutaneous cryoablation.</p> Materials and methods <p>A retrospective review of the hospital’s electronic medical record database was conducted to identify patients who underwent percutaneous image-guided cryoablation for aneurysmal bone cysts between March 2014 and April 2024. Patients were excluded if they lacked pre- or post-treatment MRI, underwent surgical curettage and bone grafting between cryoablation treatments, or received adjunctive therapies such as sclerotherapy or bone grafting. Demographic data and pre- and post-cryoablation MRI characteristics of the lesions were collected and analyzed.</p> Results <p>We retrospectively analyzed 20 patients (mean age = 14.6&#xa0;years). The average ABC volume decreased from 83 cm³ pre-treatment to 32.7 cm³ post-treatment. In the final post-treatment MRI, there was a 50% decrease in the cystic component in 90% (<i>n</i> = 18) of patients, improved cortical integrity in 75% (<i>n</i> = 9), resolution of peri-lesional edema and mass effect in all (<i>n</i> = 20), and development of organized fibrosis in 50% (<i>n</i> = 10) of the patients. The average time was 8.3&#xa0;months for a 50% reduction in cystic component, 7.3&#xa0;months for improvement in cortical integrity, 6.4&#xa0;months for improvement in mass effect, 15&#xa0;months for complete resolution of peri-lesional enhancement, and 16.1&#xa0;months for the development of organized fibrosis.</p> Conclusion <p>These findings suggest MRI is a valuable tool for monitoring ABC response to cryotherapy, guiding future treatment protocols.</p> Graphical Abstract <p></p>