Introduction: This study evaluates the role of image-guided cryoablation of small renal masses in contemporary surgical practice, assessing its impact on clinical outcomes, procedural accuracy, and patient safety in a retrospective matched cohort analysis. Materials and Methods: A retrospective matched cohort study was conducted on 250 patients from January 2016 to December 2022 at a tertiary care center. Patients were divided into CT-guided cryoablation (n=125) and Partial nephrectomy (n=125) groups. Primary outcomes included procedural success rate, complication rates, and clinical efficacy measures. Results: The CT-guided cryoablation group demonstrated significantly improved primary outcomes compared to Partial nephrectomy (p<0.05). Complication rates were lower in the study group, and procedural efficiency was maintained or improved. Multivariate analysis confirmed the imaging modality as an independent predictor of favorable outcomes. Conclusion: The findings support the integration of advanced imaging guidance in surgical practice, demonstrating measurable improvements in accuracy, safety, and clinical outcomes that justify the investment in imaging technology.