Percutaneous laser photocoagulation of osteoid osteomas under CT guidance

AIM: The aim was to evaluate laser photocoagulation and the use of the Bonopty needle system in the treatment of osteoid osteoma. MATERIALS AND METHODS: Five patients with osteoid osteomas were treated with computed tomography (CT)-guided, percutaneous laser photocoagulation using the Bonopty biopsy system. RESULTS: Complete pain relief was obtained in four patients. In one patient, pain persisted until the 6 weeks follow-up but resolved within 24 h of repeating the procedure. There were no complications, and patients remained symptom free at follow-up of 4-23 months (mean, 14 months). CONCLUSION: CT-guided laser photocoagulation of osteoid osteoma is a minimally invasive technique that represents a cost-effective alternative to surgical excision. The Bonopty needle system allows successful penetration of the sclerotic bone surrounding the nidus with manual pressure alone.     

MR imaging-guided laser ablation of osteoid osteomas with use of optical instrument guidance at 0.23 T

The purpose of this study was to determine the feasibility and features of low-field MR imaging in performing interstitial laser ablation of osteoid osteomas. Between September 2001 and April 2002, five consecutive patients with clinical and imaging findings suggesting osteoid osteoma and referred for removal of osteoid osteoma were treated with interstitial laser treatment. A low-field open-configuration MRI scanner (0.23 T, Outlook Proview, Philips Medical Systems, Finland) with optical instrument guidance hardware and software was used. Laser device used was of ND-Yag type (Fibertom medilas, Dornier Medizin Technik, Germany). A bare laser fiber (Dornier Medizin Technik, Germany) with a diameter of 400 μm was used. Completely balanced steady-state (CBASS; true fast imaging with steady precession) imaging was used for lesion localization, instrument guidance, and thermal monitoring. A 14-G (Cook Medical, USA) bone biopsy drill was used for initial approach. Laser treatment was conducted through the biopsy canal. All the lesions were successfully localized, targeted, and treated under MRI guidance. All the patients were symptom free 3 weeks and 3 months after the treatment. There was one recurrence reported during follow-up (6 months). The MRI-guided percutaneous interstitial laser ablation of osteoid osteomas seems to be a feasible treatment mode.     

Computed tomography in suspected osteoid osteomas of tubular bones

Six cases of suspected osteoid osteoma of tubular bones were evaluated by computed tomography (CT). In all cases a radiolucent nidus was clearly demonstrated. In two cases a radiodense center of the nidus was visualized. It is suggested that CT may replace conventional tomography in the evaluation of these lesions. Due to its ability to locate the lesion in the transverse plane, CT is superior for the exact planning of surgery to avoid unnecessary large or misdirected resections. Adequate window settings are essential in the evaluation of these lesions.     

Didactic review of 175 radionuclide-guided excisions of osteoid osteomas

The complete removal of a lesion which resembles, or is covered by adjacent tissue may be difficult. Therefore, the capacity of certain lesions to specifically concentrate a radiopharmaceutical has been used to orient progress during surgery. Usually, the measurements of radioactivity in the operative field are carried out by means of small, handy radiation-detecting probes which can be sterilized. Intra-operative nuclear medicine or radionuclide-guided surgery has steadily gained in importance. However, this technique is not being taught. Our study, based on radionuclide-guided surgery of 175 orthopaedic patients suspected of having osteoid osteoma, is well suited to teach the particularities of intra-operative radiation detection, as well as the collaboration between the nuclear physician and the surgeon in the operating theatre.Part of this work was carried out when M.W. and A. S.-A. were at the Saint-Antoine (Paris) and Henri Mondor (Créteil) hospitals respectively.     

Percutaneous radiofrequency thermocoagulation of osteoid osteomas: factors affecting therapeutic outcome

Objective To examine factors which affect local recurrence of osteoid osteomas treated with percutaneous CT-guided radiofrequency thermocoagulation.Design and patients A prospective study was carried out on 45 patients with osteoid osteoma who underwent percutaneous radiofrequency thermocoagulation with a minimum follow-up of 12 monthsResults There were seven local recurrences (16%); all occurred within the first year. Local recurrence was significantly related to a non-diaphyseal location (P<0.01). There was no significant relationship (P=0.05) between local recurrence and age of the patient, duration of symptoms, previous treatment, size of the lesion, positive biopsy, radiofrequency generator used or the number of needle positions. There were no complications.Conclusions Osteoid osteomas in a non-diaphyseal location are statistically more likely to recur than those in a diaphyseal location when treated with CT-guided percutaneous radiofrequency thermocoagulation. This relationship between local recurrence and location has not been previously reported.     

CT-guided radiofrequency ablation of osteoid osteoma in the long bones of the lower extremity

AIM:To present our initial experience with computed tomography guided radiofrequency ablation(RFA) of osteoid osteoma(OO) in our institution.METHODS:RFA was performed on eight patients(5 males and 3 females) with clinically and radiologically diagnosed OO(femoral neck,n = 4;femoral diaphysis,n = 2;tibial diaphysis,n = 1;fibular diaphysis,n = 1).Ablation was performed using an electrode with a 10-mm exposed tip for a total of 4-6 min at a targeted temperature of 90 degrees Celsius.No cooling system was used.The intervention was accepted as technically successful if the tip of the electrode could be placed within the center of the nidus.We defined clinical success as a disappearance within 2 wk after treatment of symptoms that had manifested at presentation.RESULTS:All procedures were technically successful.No major or immediate complications were observed.Clinical success was achieved in six of eight patients in the first procedure.A second procedure was performed for two patients who had recurrent or continued pain,and one of these cases was successfully treated.The overall rate of success was 87.5%(7/8).No complication was observed.CONCLUSION:Our preliminary results indicate a favorable success rate and no complications and are compatible with the previous reports of RFA of OO.     

Chondroblastoma of the hands and feet

Objective To review the imaging findings, age and gender distribution of chondroblastoma of the hands and feet.Design and patients Twenty-five cases of pathologically proven chondroblastoma of the hands and feet were reviewed. Available imaging modalities included radiographs (n=24), CT (n=3), MRI (n=5), and radionuclide bone scintigraphy (n=1). The following imaging features for each case were tabulated: location, presence of sclerotic margin, calcification, expansion, presence of fluid/fluid levels on cross-sectional imaging and surrounding edema on MRI. The images were evaluated for skeletal maturity using closure of the physeal plate in the region as a standard.Results The average age at time of diagnosis was 23 years (range 7–57 years). Eighty-four percent (n=21) of the patients were skeletally mature. Males (20 of 25) outnumbered females by a ratio of 5:1. The bones of the foot accounted for 22 cases: calcaneus (n=8), talus (n=8), metatarsals (n=3), and the cuboid (n=3). The bones of the hand accounted for three cases: phalanx (n=1), triquetrum (n=1), and a metacarpal (n=1). Radiographically all lesions were osteolytic with identifiable calcification in 54% (13 of 24). Fluid/fluid levels were seen in four of five cases on MRI. Edema on MR images was seen in 40% (2 of 5). The size of the lesions ranged from 2 to 41 cm².Conclusion Chondroblastomas of the hands and feet share many of the radiographic characteristics seen in the long bones, but manifest in skeletally mature patients with a higher male to female ratio than in long bone chondroblastoma. Talar and calcaneal lesions were encountered only in males. Chondroblastoma of the wrist and hand appears to be exceptionally rare.Presented at the special scientific session of the International Skeletal Society held in San Francisco, California, USA, September 2003     

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

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.     

CT-guided radiofrequency ablation of osteoid osteoma and osteoblastoma: Clinical success and long-term follow up in 77 patients

The purpose of this study was to retrospectively evaluate long-term success of CT-guided radiofrequency ablation (RFA) in patients with osteoid osteoma (OO) and osteoblastoma (OB) including tumors in critical locations. Eighty-one CT-guided RFA procedures were performed in 77 patients with OO (65 patients) and OB (12) including 6 spinal and 15 intra/periarticular tumors. Procedural techniques included multiple needle positions, three-dimensional access planning, as well as, thermal protection techniques. Long-term success was assessed using a questionnaire including, among others, several VAS (visual analogue scale) scores. All patients completed 3–6 months follow-up, overall response to the questionnaire was 64/77 (83.1%). Primary success rate was 74/77 (96.1%) of all patients. Retreatment with RFA in 3 patients resulted in a secondary success rate of 77/77 (100%). Long-term follow-up (mean, 38.5 months; range, 3–92) revealed a highly significant (p < 0.001) reduction of all assessed limitation scores reaching normal or almost normal values. One major complication, a cannula break leading to a secondary short hospital stay, occurred. In conclusion, RFA is a safe and effective long-lasting treatment of OO and OB. Advanced procedural techniques aid treating tumors in critical locations and in the coverage of larger tumors. Besides night pain, RFA also greatly improves other factors negatively affecting the quality of life.     

CT-guided radiofrequency ablation of spinal osteoid osteomas with concomitant perineural and epidural irrigation for neuroprotection

Here we report our experience of a neuroprotective adaptation of the technique of CT-guided radiofrequency (RF) ablation of spinal osteoid osteomas. Over 9 years seven patients underwent eight CT-guided RF treatments for osteoid osteoma. CT-guided RF ablation was performed with general anaesthesia. The lesion was heated to 90°C for 2 min for two cycles by using a Cosman SMK TC-10 RF electrode. This was preceded by a bolus of room temperature sterile water (10 ml) injected through a 26G curved spinal needle into the exit foramen and adjacent epidural space for neuroprotection. The age of the patient, sex, lesion location, biopsy results and complications were recorded. All the biopsies (n = 7) demonstrated histological features of osteoid osteoma. All the procedures were technically successful. Clinical success was assessed up to 3 years post procedure. There was an 85% clinical success rate (6 of the 7 patients), with recurrence of a lesion at 6 months, necessitating a repeat procedure (successful). CT-guided percutaneous RF ablation of spinal osteoid osteoma preceded by bolus of sterile water, injected through a spinal needle into the exit foramen and adjacent epidural space for neuroprotection, is a safe and effective procedure.     

Intra-articular hip joint osteoid osteoma: Challenging diagnosis and percutaneous radiofrequency ablation treatment

Atypical intra-articular osteoid osteoma can be difficult to diagnose and challenging to treat. We report a case of a right acetabular subchondral intra-articular osteoid osteoma in a young male patient which was initially diagnosed as femoroacetabular impingement due to its atypical clinical and radiological presentations. After fully working up the patient the lesion was successfully treated with percutaneous CT-guided low-power bipolar radiofrequency ablation using several per procedural articular cartilage thermal protective measures including intra-articular thermocouple, and continuous per procedural joint space cooling with Dextrose 5% solution. A precise RFA electrode placement, using the No-touch technique, and applying different passive and active thermal protective measures were helpful in avoiding collateral damage of the hip joint articular cartilages. atypical intra-articular osteoid osteomas necessitate pertinent correlation between the clinical and radiological presentations. As far as intra-articular or subchondral nidus ablation is concerned, thermal protective measures should be considered.     

Postinterventional MRI findings following MRI-guided laser ablation of osteoid osteoma

Objective

To evaluate postinterventional magnetic resonance imaging (MRI) characteristics following MRI-guided laser ablation of osteoid osteoma (OO).

Materials and methods

35 patients treated with MRI-guided laser ablation underwent follow-up MRI immediately after the procedure, after 3, 6, 12, 24, 36, and up to 48 months. The imaging protocol included multiplanar fat-saturated T2w TSE, unenhanced and contrast-enhanced T1w SE, and subtraction images. MR images were reviewed regarding the appearance and size of treated areas, and presence of periablation bone and soft tissue changes. Imaging was correlated with clinical status.

Results

Mean follow-up time was 13.6 months. 28/35 patients (80%) showed a postinterventional “target-sign” appearance consisting of a fibrovascular rim zone and a necrotic core area. After an initial increase in total lesion diameter after 3 months, a subsequent progressive inward remodeling process of the zonal compartments was observed for up to 24 months. Periablation bone and soft tissue changes showed a constant decrease over time. MR findings correlated well with the clinical status. Clinical success was achieved in 32/35 (91%).

Conclusions

Evaluation of long-term follow-up MRI after laser ablation of OO identified typical postinterventional changes and thus may contribute to the interpretation of therapeutic success and residual or recurrent OO in suspected cases.     

Percutaneous treatment of osteoid osteoma by laser thermocoagulation under computed tomography guidance in pediatric patients

To evaluate the efficiency of laser thermocoagulation under computed tomography (CT) guidance in the treatment of osteoid osteoma within a strictly pediatric group. Twenty-five patients aged 4 to 17 years were treated under CT by laser thermocoagulation. The nidus measured on average 10.1 mm. Pain relief was the main item for evaluation of the effectiveness of our treatment. Follow-up ranged from 3 months to 61 months (mean, 26 months). Technical success was achieved in 100%. Thermocoagulation proved to be initially effective in 24 of 25 children (96%) and had a positive long-term effect in 23 of 25 children (92%). We had four minor complications and one severe complication (partial osteonecrosis of the talus). Laser thermocoagualation is an effective treatment for osteoid osteoma in pediatric patients.     

Radiofrequency thermoablation of primary non-spinal osteoid osteoma: optimization of the procedure

Osteoid osteoma is a small benign tumor that requires treatment due to the intense pain it causes. Surgical therapy has been the ablative technique of choice after a failure of medical therapy. Recently, numerous less invasive, alternative procedures have been proposed: drill trepanation with or without ethanol injections, cryoablation, and thermoablation with laser or radiofrequency. The aim of this review is to retrospectively assess the effect of radiofrequency (RF) thermoablation in the treatment of primary non-spinal osteoid osteoma. From June 2001 to July 2003, we treated 106 patients affected by osteoid osteoma with RF thermoablation. Five patients with spinal osteoid osteoma and four with a previously treated osteoma were excluded from the study. In this paper, we assess the results obtained in a selected group of 97 primary non-spinal osteoid osteoma. The lesions were predominantly in the metaphysics of the femur. Central nidus calcifications were frequent and there was no prevalence for which side they occurred. Primary success was achieved in 82 patients (85%), while we obtained secondary success in 15 patients (15%). In two patients (2%), pain persisted between the two treatments and failed to be resolved, even after the second treatment; therefore, surgical excision was performed and complete resolution was obtained. No complications were reported. In conclusion, our results confirm that the treatment of choice for non-spinal osteoid osteoma is RF thermoablation, offering several advantages over ablative techniques.     

Familial occurrence of osteoid osteoma

Familial occurrence of osteoid osteoma is an exceedingly rare event. This paper describes the second report of this event, where two siblings presented with this lesion in the same location, the proximal left femur. They both presented at 6 years of age, but 3 years apart.     

骨样骨瘤的影像诊断

目的评价平片、CT,MRI对骨样骨瘤的诊断价值.方法18例骨样骨瘤均摄平片,其中16例经CT检查,4例行MRI检查;分析骨样骨瘤的平片、CT,MBI影像学表现.结果骨样骨瘤典型表现为瘤巢及周围反应性骨质硬化,且随病变部位不同而有所差异.诊断准确性平片为92.9%,CT为100%,MRI为83.3%.结论平片是诊断骨样骨瘤的基本手段,CT为最可靠方法,MRI需结合平片、CT进行诊断.     

Unusual manifestation of an osteoid osteoma of the capitate

A case of osteoid osteoma of the capitate in a 29-year-old male is reported. The patient suffered from unspecific clinical findings and a 3-year history of uncharacteristic wrist pain. Conventional radiographs of the wrist revealed a circumscribed sclerosis in the proximal part of the capitate bone beside a diffuse demineralisation of the carpal bones. Magnetic resonance imaging demonstrated a circumscribed, tumorous lesion with marked enhancement after IV administration of contrast agent and a highly calcified nidus, which was sharply demarcated by a small rim of granulation tissue from the surrounding spongious bone. Based on MRI findings, the diagnosis of an osteoid osteoma was established and confirmed after operation and histologic analysis. Received: 17 December 1997; Revision received: 30 September 1998; Accepted: 7 October 1998     

Arthroscopic excision of the osteoid osteoma at the distal femur

Osteoid osteoma is a benign, osteoblastic and painful tumoral lesion. Apart from en-bloc resection, intralesional resection and percutaneous excision or destruction of the nidus, arthroscopic removal of the lesion in intraarticular locations have been reported. We present a patient with osteoid osteoma at distal femur which is accessible through knee joint, treated by arthroscopic complete excision. Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users.