Radiol Med. 2005 May-June;109(5-6):555-562.

Radiofrequency thermal ablation of non spinal osteoid osteoma: remarks on method.

Albisinni U, Rimondi E, Malaguti MC, Ciminari R, Bianchi G, Mercuri M.

Servizio di Radiologia e Diagnostica per Immagini, Istituto Ortopedico Rizzoli, Bologna, Italy.

Osteoid osteoma is a small benign tumor, with a ''nidus'' that rarely exceeds 15 mm in diameter. It is relatively common in males, especially teenagers and young adults. It involves mainly the appendicular skeleton, the femur in particular, and rarely the axial skeleton. It requires treatment because it causes intense pain. In recent years alternative, less invasive, treatments have been proposed, such as drilling combined with ethanol injections, and thermal ablation with laser or radiofrequency. This study assesses 117 patients affected by osteoid osteoma, treated by radiofrequency thermal ablation between June 2001 and November 2003. We describe the patient recruitment procedure, CT-guided technique, the percutaneous approach, thermal ablation, and the instruments used. Data were analyzed thoroughly, and modifications that have improved the effects of treatment have been highlighted. The results achieved since the method was perfected have been extremely encouraging, confirming that the technique is very effective if performed correctly. For that reason radiofrequency thermal ablation has become the treatment of choice for non-spinal osteoid osteoma at Rizzoli Orthopaedic Institute.

Eur Radiol. 2004 Jul;14(7):1203-8. Epub 2004 Mar 10.

CT-guided radiofrequency ablation of osteoid osteoma: long-term results.

Cioni R, Armillotta N, Bargellini I, Zampa V, Cappelli C, Vagli P, Boni G, Marchetti S, Consoli V, Bartolozzi C.

Department of Oncology, Transplants and Advanced Technologies in Medicine, Division of Diagnostic and Interventional Radiology, University of Pisa, Via Roma 67, 56126 Pisa, Italy.

The aim of the study was to assess the safety and efficacy of CT-guided percutaneous radiofrequency (RF) ablation of osteoid osteoma (OO). From 1997 to 2001, RF ablation was performed on 38 patients with OO, diagnosed clinically and by radiography, scintigraphy, contrast-enhanced MRI, and CT. Treatment was performed via percutaneous (n=29) or surgical (n=9) access, under CT guidance in all cases, with an 18-gauge straight electrode. Patients were discharged within 24 h and followed up clinically (at 1 week and every 6-12 months) and with MRI (at 6 months) and scintigraphy (after 1 year). The technical success rate was 100%. Complications occurred in two patients, consisting in local skin burns. The follow-up range was 12-66 months (mean +/- SD, 35.5+/-7.5 months). Prompt pain relief and return to normal activities were observed in 30 of 38 patients. Persistent pain occurred in eight patients; two patients refused further RF ablation and were treated surgically; RF ablation was repeated in six cases achieving successful results in five. One patient reported residual pain and is being evaluated for surgical excision. Primary and secondary clinical success rates were 78.9 (30/38 patients) and 97% (35/36 patients), respectively. CT-guided RF ablation of OO is safe and effective. Persistent lesions can be effectively re-treated. Several imaging modalities are needed for the diagnosis of OO and for the follow-up after treatment, particularly in patients with persistent symptoms.

Radiology. 2003 Oct;229(1):171-5. Epub 2003 Aug 27.

Osteoid osteoma: percutaneous treatment with radiofrequency energy.

Rosenthal DI, Hornicek FJ, Torriani M, Gebhardt MC, Mankin HJ.

Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 199 Cambridge Street, Boston, MA 02114, USA.

PURPOSE: To report our experience with technical success, complications, and long-term clinical success of radiofrequency (RF) ablation of osteoid osteoma. MATERIALS AND METHODS: After needle biopsy, computed tomography (CT)-guided percutaneous RF ablation was performed with general or spinal anesthesia. With an RF electrode, the lesion was heated to 90 degrees C for 6 minutes. Patient age and sex, lesion size and location, biopsy results, and complications were recorded. Clinical success was assessed at a minimum of 2 years after the procedure. Significance of patient age and sex and lesion location and size as a predictor of biopsy result was tested by means of chi2 analysis. In addition, effects of patient age and sex, lesion location and size, and biopsy results on clinical success were tested with the Fisher exact test. RESULTS: During an 11-year period, 263 patients who were suspected of having osteoid osteoma underwent 271 ablation procedures. All procedures were technically successful. There were two anesthesia-related complications (aspiration, cardiac arrest) and two minor procedure-related complications (cellulitis, sympathetic dystrophy). Results at biopsy were positive in 73% (197 of 271 biopsies). Two-year follow-up data were available for 126 procedures. The other procedures had been performed more recently or the patients could not be contacted. There was complete relief of symptoms after 112 of the 126 procedures (89%). For procedures performed as the initial treatment, the success rate was 91% (107 of 117 procedures). Procedures for recurrent lesions had a significantly lower success rate (six of 10 procedures [60%], P <.001). Clinical outcome was not dependent on biopsy result, patient age or sex, or lesion size or location. CONCLUSION: CT-guided percutaneous RF ablation of osteoid osteoma is a safe and effective technique.

J Vasc Interv Radiol 2001 Jun;12(6):717-22

Osteoid osteoma: CT-guided percutaneous radiofrequency ablation and follow-up in 47 patients.

Woertler K, Vestring T, Boettner F, Winkelmann W, Heindel W, Lindner N.

Department of Radiology, Klinikum Rechts der Isar, Technische Universitaet Muenchen, Munich, Germany. PURPOSE: To evaluate computed tomography (CT)-guided radiofrequency (RF) ablation as a minimally invasive therapy for osteoid osteoma with regard to technical and clinical success and immediate and delayed complications. MATERIALS AND METHODS: Forty-seven patients (age range, 8-41 y; mean age, 19.6 y) with osteoid osteomas (femur, n = 25; tibia, n = 15; pelvis, n = 2; humerus, n = 1; ulna, n = 1; talus, n = 1; calcaneus, n = 1; vertebral body, n = 1) were treated with CT-guided RF ablation in 15 cases after one (n = 10) or two (n = 5) unsuccessful attempts at open surgical resection. Percutaneous therapy was performed with use of general or spinal anesthesia. After localization of the nidus with 1-3-mm CT sections, osseous access was established with either a 2-mm coaxial drill system or an 11-gauge Jamshidi needle. RF ablation was performed at 90 degrees C for a period of 4-5 minutes with use of a rigid RF electrode with a diameter of 1 mm. The procedures were regarded as technically successful if the tip of the RF electrode could be placed within the center of the nidus and could be heated to the desired temperature. Clinical success of treatment was defined as permanent relief of pain and return to normal function without additional treatment. In case of persistence or recurrence of symptoms after RF ablation, treatment was regarded as secondarily successful if permanent relief of symptoms could be achieved in a second procedure. RESULTS: All procedures were technically successful. Clinical success was achieved in 94% of patients (44 of 47). Three patients had recurrence of pain 3, 5, and 7 months after treatment, respectively (mean observation interval, 22 mo). All recurrences were treated successfully in a second procedure (secondary success rate, 100%). No immediate or delayed complications were observed. CONCLUSION: CT-guided percutaneous RF ablation is a simple, minimally invasive, safe and highly effective technique for treatment of osteoid osteoma.

J Bone Joint Surg Br 2001 Apr;83(3):391-6

Percutaneous radiofrequency ablation in osteoid osteoma.

Lindner NJ, Ozaki T, Roedl R, Gosheger G, Winkelmann W, Wortler K.

Department of Orthopaedics, Westfalische Wilhelms Universitat, Munster, Germany.

We treated 58 patients with osteoid osteoma by CT-guided radiofrequency ablation (RF). In 16 it followed one or two unsuccessful open procedures. It was performed under general anaesthesia in 48, and spinal anaesthesia in ten. The nidus was first located by thin-cut CT (2 to 3 mm) sections. In hard bony areas a 2 mm coaxial drill system was applied. In softer areas an 11-gauge Jamshidi needle was inserted to allow the passage of a 1 mm RF probe into the centre of the nidus. RF ablation was administered at 90 degrees C for a period of four to five minutes. Three patients had recurrence of pain three, five and seven months after treatment, respectively, and a second percutaneous procedure was successful. Thus, the primary rate of success for all patients was 95% and the secondary rate was 100%. One minor complication was encountered. CT-guided RF ablation is a safe, simple and effective method of treatment for osteoid osteoma.

J Vasc Interv Radiol 2001 Oct;12(10):1135-48

Image-guided radiofrequency tumor ablation: challenges and opportunities--part II.

Dupuy DE, Goldberg SN.

Department of Radiology, Rhode Island Hospital, Brown University School of Medicine, Providence, Rhode Island, USA.

AJR Am J Roentgenol 2001 Dec;177(6):1391-5

Intraarticular osteoid osteoma: sonographic findings in three patients with radiographic, CT, and MR imaging correlation.

Ebrahim FS, Jacobson JA, Lin J, Housner JA, Hayes CW, Resnick D.

Department of Radiology, University of Michigan Medical Center, 1500 E. Medical Center Dr, Ann Arbor, MI 48109-0326, USA.

OBJECTIVE: Intraarticular osteoid osteoma often has subtle radiographic findings and nonspecific clinical features; further diagnostic workup of unexplained joint pain may involve musculoskeletal sonography. We describe the sonographic features of intraarticular osteoid osteoma in three consecutive patients with radiographic, CT, and MR imaging correlation. CONCLUSION: The sonographic findings of painful cortical irregularity and focal synovitis should raise the possibility of intraarticular osteoid osteoma, prompting the search for characteristic findings on correlative imaging studies.

Foot Ankle Int 2000 Jul;21(7):596-8

Percutaneous CT guided resection of osteoid osteoma of the tibial plafond.

Donley BG, Philbin T, Rosenberg GA, Schils JP, Recht M.

Cleveland Clinic Foundation,Department of Orthopaedic Surgery, OH, 44195, USA.

Osteoid osteomas of the foot and ankle are relatively rare and notoriously difficult to diagnose. Juxta-articular osteoid osteomas are more difficult to treat and often have a significant delay in diagnosis. We report a case of a juxta-articular osteoid osteoma of the tibial plafond. Once the diagnosis was made, excisional biopsy was performed percutaneously under computed tomography (CT) guidance as an outpatient in the radiology suite. The patient had complete resolution of symptoms and remains pain free at two years follow-up. CT guided resection can be a lower morbidity and more cost effective technique to treat this lesion than traditional methods.

Clin Imaging 2000 Jan-Feb;24(1):19-27

Osteoid osteoma: MR imaging revisited.

Spouge AR, Thain LM.

Department of Diagnostic Radiology, London Health Sciences Centre, University Campus, 339 Windermere Road, N6A 5A5, London, Ontario, Canada.

To assess and compare with computed tomography (CT) the performance of magnetic resonance (MR) imaging in the detection of osteoid osteoma, and determine the features of this lesion on MR imaging. The prospective MR imaging and CT diagnosis of osteoid osteoma was determined from original radiology reports. MR images were assessed retrospectively with regard to the location and signal intensity of the nidus and surrounding bone marrow and soft tissue edema. These findings were correlated with the age of the patient, duration of symptoms, and drug therapy. Ten patients with histologically proven osteoid osteoma who underwent MR imaging were reviewed. All 10 lesions were correctly diagnosed at the time of MR imaging. None of the lesions was intracortical. Nine lesions were intra-articular. Two out of five patients with extracortical lesions had false negative CT preceding the MR study. Signal intensity of the nidus, marrow, and soft tissue edema on MR imaging were variable. Perinidal edema was most pronounced in younger patients and had no apparent relation to drug therapy. MR imaging reliably demonstrates the nidus of an osteoid osteoma, which has a variable appearance related to its position relative to the cortex of the bone. A predominance of cancellous osteoid osteomas are encountered in patients referred for MR imaging. Marrow edema in the vicinity of the lesion improves the conspicuity of the nidus. CT may fail to diagnose osteoid osteoma when the nidus is in a cancellous location, due to the lack of perinidal density alteration.

Spine 2000 May 15;25(10):1283-6

Osteoid osteoma of the spine treated with percutaneous computed tomography-guided thermocoagulation.

Cove JA, Taminiau AH, Obermann WR, Vanderschueren GM.

Department of Orthopaedic Surgery, and the Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands.

STUDY DESIGN: Two cases are reported in which an osteoid osteoma of the lumbar spine was treated with CT-guided thermocoagulation. OBJECTIVES: To review an alternative and minimally invasive treatment for spinal osteoid osteomas. SUMMARY OF BACKGROUND DATA: Surgical resection of a spinal osteoid osteoma can, depending on the location, be a formidable undertaking. Bone scintigraphy can be helpful in intraoperative identification. More recently, resection through a computed tomography-guided drill hole was found to minimize exposure. Using a thermocoagulation probe, as has been used in osteoid osteoma of the extremities, may be technically easier and cause less morbidity. METHOD: With the patient under general anesthesia, a bone biopsy cannula was introduced into the center of the osteoid osteoma. Material was subjected to histologic examination. A thermocoagulation probe was then inserted and heated to 90 C for 4 minutes. The two patients were kept overnight for observation. RESULTS: Both patients had complete pain relief and no evidence of recurrence after 2 years' follow-up. There were no complications. Scoliosis resolved in one patient and persisted in the other. CONCLUSION: Percutaneous computed tomography-guided thermocoagulation is a minimally invasive and technically straightforward method to achieve ablation of a spinal osteoid osteoma. No complications were encountered in these two patients. Future research should focus on the safety of thermocoagulation, especially cephalad to the level of the conus medullaris.

Skeletal Radiol 1999 Feb;28(2):107-10

Doppler duplex color localization of osteoid osteomas.

Gil S, Marco SF, Arenas J, Irurzun J, Agullo T, Alonso S, Fernandez F.

Department of Diagnostic Radiology, University General Hospital of Alicante, Spain.

We present two cases of osteoid osteoma in adolescent boys. The lesions were located in the proximal metaphysis of the right tibia and left femoral diaphysis respectively. Doppler duplex color study demonstrated clearly the highly vascular nidus and its feeding artery in one case and only the feeding artery in the second. We believe these are the first descriptions of osteoid osteomas assessed with Doppler duplex color, which was also used as guidance for the percutaneous localization and biopsy.

Semin Musculoskelet Radiol 1997;1(2):281-284

Percutaneous Treatment of Osteoid Osteomas: Combonation of Drill Biopsy and Subsequent Ethanol Injection.

Adam G, Neuerburg J, Vorwerk D, Forst J, Gunther RW.

Department of Diagnostic Radiology and Orthopedic Surgery, University of Technology Aachen, Germany.

Osteoid osteoma is known as a benign bone-producing tumor. Histologically, it is characterized by a highly vascularized connective tissue with fibrous bone trabeculae, osteoid, osteoblasts, and numerous osteoclasts. Clinically, patients complain of pain during the night with good response to acetylsalicylic acid. Conventional radiographs show a spindle-shaped lesion with a central lucency not larger than 1 cm in size, which represents the nidus. Osteoid osteomas are most common in the diaphysis of the long bones. A successful therapy requires complete removal of the nidus, either surgically or percutaneously. Our experience is with CT-guided percutaneous drilling of the nidus with subsequent ethanol injection to sclerose remnants of the nidus.

Nucl Med Commun 1996 Dec;17(12):1006-15

Intra-operative nuclear medicine in surgical practice.

Perkins AC, Hardy JG.

Department of Medical Physics, University Hospital, Queen's Medical Centre, Nottingham, UK.

The use of radionuclides for the intra-operative localization of tumours has increased steadily over the past 15 years. We reviewed more than 15 years experience of a peripatetic service using a sterilizable probe system in operating theatres throughout the UK for localizing bone and soft tissue lesions. The technique requires the positive concentration of an appropriate radiopharmaceutical, together with a suitably designed detector system which can be sterilized for use during surgery. All surgical procedures were undertaken following initial positive imaging studies. A well-collimated nuclear probe with a 5 mm diameter CdTe detector was sterilized with ethylene oxide gas and coupled to a digital counter and ratemeter for use in the operating theatre. A total of 68 surgical procedures have been undertaken at 35 hospitals. Fifty-eight patients underwent excision of osteoid osteoma subsequently proven by histology. The other lesions successfully resected included osteoblastoma, hamartoma, Brodie's abscess, chronic bone infection, ectopic parathyroid adenoma and metastatic neuroblastoma. The technique can now be regarded as the method of choice for the surgical localization of osteoid osteoma. The successful detection of lesions at surgery can be assured providing that clear localization of the radiopharmaceutical occurs on the pre-operative images. The intra-operative use of conventional and new tumour-specific radiopharmaceuticals is reviewed and we confirm an increasing role for the surgical-probe-guided localization of primary and metastatic tumours.

Radiol Clin North Am 1996 Mar;34(2):215-31

Scintigraphy in the evaluation of arthropathy.

Tumeh SS.

Department of Radiology, Eastern Virginia Medical School, Virginia Beach, USA.

Significant progress has been made in radionuclide imaging of bones and joints. This largely is owing to advances in radiopharmaceuticals, particularly the antibodies, and in technology, particularly in the introduction of new computers and multiheaded camera systems resulting in improved imaging. These techniques have applied to the evaluation of articular and para-articular diseases including rheumatoid arthritis, septic arthritis, osteoid osteoma, transient osteoporosis, reflex sympathetic dystrophy, avascular necrosis, and facet joint syndrome. This article reviews scintigraphy in these conditions.

Curr Opin Radiol 1992;4(6):32-8

Imaging of bone tumors.

Davies AM, Wellings RM.

MRI Centre, Royal Orthopaedic Hospital, Birmingham, UK.

In the recent literature on benign bone tumors, papers have highlighted the atypical appearances of intracapsular osteoid osteoma, the characteristic (yet not pathognomonic) feature of fluid-fluid levels on CT and MR imaging of aneurysmal bone cysts, the difficulties of MR imaging of giant cell tumors laden with hemosiderin following intratumoral hemorrhage, and the reliability of ultrasound in measuring the thickness of the cartilage cap in chondroid lesions. MR imaging remains preeminent in the staging of musculoskeletal tumors, although, as yet, there has been only limited success in using this modality for tissue characterization. One study has described certain distinctive patterns on MR associated with different histologies. In particular, peritumoral edema was only found in malignant bone tumors and giant cell tumors. Subjective MR criteria would appear not to be helpful in identifying osteosarcomas patients who are good responders to chemotherapy. Intra-arterial chemotherapy for osteosarcoma of the lower limb may be complicated by infarction of the distal femur, which on MR imaging should not be mistaken for metastatic or transarticular tumor spread.

AJR Am J Roentgenol 1979 Jan;132(1):77-80

Role of radionuclide imaging in osteoid osteoma.

Lisbona R, Rosenthall L.

Radiophosphate bone scans readily disclosed osteoid osteomas in 20 symptomatic patients, including nine patients whose radiographic findings had been negative. In five of the nine patients adjuvant radiogallium imaging was performed, and four showed a disproportionately low uptake relative to radiophosphate. When this occurs, osteoid osteoma can be distinguished from subacute osteomyelitis, which is particularly helpful if the radiograph is equivocal. Radiophosphate bone imaging's generally accepted excellent sensitivity in disclosing obscure symptom-producing focal bone disorders makes it the screening procedure of choice, especially if osteoid osteoma is considered in the differential diagnosis. Only abnormal areas need to be radiographed to add specificity and more precise delineation.

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