557例非脊柱骨样骨瘤病人的射频消融治疗

目的描述非脊柱骨样骨瘤活检和CT引导下射频消融的结果,并比较程序修改之前和之后的结果。方法回顾性分析557例行活检和CT引导下射频消融治疗的非脊柱骨样骨瘤病人。68例病人行CT扫描,层厚3mm,间距2mm,     

Radiofrequency ablation for non-spinal osteoid osteomas in 557 patients

Objectives  

To present the results of biopsy and computed tomography (CT) guided radiofrequency ablation (RFA) for non-spinal osteoid osteomas, and compare the results before and after procedural modifications.     

Image-guided percutaneous radiofrequency ablation for osteoid osteomas

The authors present a retrospective analysis of the technical and clinical successes, complications, and clinical follow-up of image-guided percutaneous radiofrequency (RF) ablation of osteoid osteomas. Nine patients with osteoid osteomas underwent image-guided localization of osteoid osteomas. Outpatient percutaneous therapy (13 procedures) was performed under general anesthesia after image-guided localization of the nidus. Initial technical success was achieved in seven of nine patients. Two initial technical and clinical failures occurred early in this experience because of failure to adequately enter the nidus with use of fluoroscopic imaging alone. Clinical success was achieved in eight of nine patients. No major immediate or delayed complications were observed.     

Radiofrequency ablation in the treatment of osteoid osteoma—5-year experience

Purpose

This study aimed to determine the success and complication rates of radiofrequency ablation (RFA) in treatment of osteoid osteoma (OO) and duration of pain relief. Furthermore value of bone biopsy prior to the RFA was evaluated.

Materials and methods

Within 61 months 39 patients (23 male, 16 female, 7-53 years, mean 18.7 years, median 17 years) suffering from osteoid osteoma were treated. Lesions were located in femur (n = 20), tibia (n = 10), spine (n = 5), humerus (n = 1), radius (n = 1), talus (n = 1) and pelvis (n = 1). In children, RFA was performed under general anaesthesia, in adults conscious sedation was preferred. In 29 of 39 (74%) lesion biopsies were obtained. Cooling of skin was performed in OOs located in bones with minor soft tissue covering (tibia, radius) and saline flushing via an additional needle was performed if the OO was adjacent to nerval structures. Primary success rate, complications, symptom-free interval, follow-up and biopsy results were evaluated.

Results

Within observation period (1-61 months; median: 32 months) 38 of 39 patients were successfully treated and had no more complaints. In 3 of 38 patients relapse occurred after 1, 14 and 32 months and RFA was repeated. Two major complications (broken drill, infection) and 2 minor complications (hematoma, prolonged pain) were observed. Biopsy was able to prove diagnosis in 14 of 29 (48%) cases.

Conclusions

Biopsy prior to treatment is not mandatory due to a remarkable amount of false negative findings in clinically and morphologically unambiguous cases of OO. RFA is a highly effective, efficient, minimally invasive and safe method for the treatment of OO.     

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.     

3D-imaging of the facial skeleton with an isocentric mobile C-arm system (Siremobil Iso-C3D)

OBJECTIVES: The purpose of this study was to compare three-dimensional (3D) imaging of the facial skeleton using an isocentric mobile C-arm system vs CT. METHODS: A dried human skull was scanned using a Siremobil Iso-C3D and a multi-detector CT (SOMATOM Volume Zoom; Siemens Medical Solutions, Erlangen, Germany) to compare reconstructed data sets. For each group of scans a standard protocol and a high resolution protocol were used. Image quality was analysed using six anatomical and six virtual structures in the primary reconstructed axial images of both data sets of the Siremobil Iso-C3D compared with CT. A receiver operating characteristic (ROC) study was performed with six examiners. RESULTS: The original categorical response data revealed no significant differences in sensitivity and specificity (P < 0.05). However, image quality of the reconstructed images of the Siremobil Iso-C3D was inferior to the CT images, with metal artefacts having a more prominent negative effect. CONCLUSIONS: The Siremobil Iso-C3D produces 3D images of the facial skeleton suitable for imaging osseous structures. No significant differences were found in sensitivity or specificity between the two methods. Metal objects degrade the image from the Iso-C method to a greater extent than those from CT.     

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.     

Radiofrequency ablation of osteoid osteoma: initial results with a bipolar ablation device

PURPOSE: To report the initial results with percutaneous radiofrequency (RF) ablation of osteoid osteomas with a bipolar ablation device. MATERIALS AND METHODS: Twelve patients (seven male patients and five female patients; mean age, 17.3 years; age range, 6-36 y) with clinically and radiologically suspected osteoid osteoma were treated with computed tomography-guided percutaneous bipolar RF ablation. The procedure was performed with the patients under general anesthesia. After localization of the nidus, an 11-gauge hollow drill was introduced into the nidus through a 9-F introducer sheath. A bipolar 18-gauge RF probe with a 9-mm active tip was inserted through the introducer sheath and connected to the RF generator. Energy application was started at 2 W and subsequently increased to a maximum of 5 W. The procedure was terminated if a resistance of 900 Omega was reached. RESULTS: Mean duration of energy deposition was 8.3 +/- 4.0 minutes, with a mean energy application of 1.8 +/- 2.9 kJ (range, 0.3 - 7 kJ). In one patient, the intervention had to be repeated twice to achieve total pain relief. Eleven of 12 patients (92%) remained free of symptoms at a follow-up time of 15.1 +/- 9.5 months (range, 5 - 31 months). One patient had recurrence of pain 16 months after the procedure and was treated surgically. No complications occurred. Patients resumed normal activity within 24 hours. CONCLUSIONS: Percutaneous bipolar RF ablation is an efficient and safe treatment of osteoid osteoma. Short-term efficacy of bipolar RF ablation may rival the results of monopolar RF ablation. Further studies are needed to address the long-term efficacy of this technique.     

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

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.     

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.     

Intraoperative 3D imaging of the facial skeleton using the SIREMOBIL Iso-C3D

OBJECTIVES: With respect to high-contrast structures, cone beam computed tomography (CBCT) offers an alternative imaging modality to computed tomography (CT), requiring less radiation exposure. The C-arm system SIREMOBIL Iso-C3D for three-dimensional (3D) reconstruction has made this modality available for intraoperative use. This paper presents the first intraoperative images of the facial skeleton using the SIREMOBIL Iso-C3D. METHODS: Cases of a zygomaticomaxillary complex fracture, a mandibular angle fracture and a bimaxillary repositioning osteotomy are described to demonstrate the application possibilities of this system in maxillofacial surgery. RESULTS: In addition to the uncomplicated handling of the SIREMOBIL Iso-C3D, generally important was the low level of metal artefacts in its primary and secondary reconstructions, even in close proximity to the material. However, it has to be kept in mind that while soft tissues are visualized using CBCT, information about soft tissue quality cannot be obtained. CONCLUSION: The SIREMOBIL Iso-C3D generates intraoperative data sets suitable for the visualization of the facial bones after open reduction of fractures.     

射频消融髓核成形术治疗颈椎间盘突出症

目的探讨射频消融髓核成形术治疗颈椎间盘突出症的安全性和疗效。方法应用射频消融髓核成形术治疗颈椎间盘突出症22例,男19例、女3例;年龄18～35岁,平均(25.5±4.5)岁。共23个椎间隙:单间隙21例,双间隙1例。术后随访近期效果。结果本组22例患者均获随访,随访时间1～12个月,平均7.6个月。显效17例,有效4例,无效1例,总有效率95.45%。结论射频消融髓核成形术是治疗颈椎间盘突出症行之有效的方法,这种技术简单、微创、安全、疗效肯定。关键是选择合适的适应证。     

Radiofrequency ablation versus magnetic resonance guided focused ultrasound surgery for minimally invasive treatment of osteoid osteoma: a propensity score matching study

Objectives

To compare outcomes in pain relief and motor functional recovery in patients with an osteoid osteoma treated by magnetic resonance guided focused ultrasound surgery (MRgFUS) or radiofrequency ablation (RFA) using a propensity score matching study design.

Methods

Thirty patients with osteoid osteomas were included in this institutional review board (IRB)-approved study. MRgFUS was performed in 15 subjects. These subjects were matched by propensity analysis with a group of 15 subjects treated by RFA. Pain relief in terms of complete response (CR) and motor functional recovery were measured.

Results

A similar proportion of subjects treated by MRgFUS (94 %) or RFA (100 %) experienced CR 12 weeks after treatment, with no significant difference. The improvement in pain control following MRgFUS or RFA paralleled with improved motor functional recovery. The treatment failure rate was 6.6 % in the MRgFUS group and 0 % in the RFA group. No major complications were observed following either ablative treatment.

Conclusions

Although this study involved a limited number of patients, MRgFUS favourably improves perceived pain and motor functional recovery, with no major complications. No difference was found in the achievement of primary and secondary outcome measures with respect to RFA.

Key Points

? To demonstrate the effectiveness of a recent technique for treating osteoid osteoma ? MRgFUS results compared with results of the gold standard treatment (RFA) ? MRgFUS is effective both from a clinical and functional point of view ? No significant side effects compared with RFA

     

CT-guided percutaneous laser photocoagulation of osteoid osteomas of the hands and feet

Percutaneous local ablation of osteoid osteoma has largely replaced surgery, except in the small bones of the hands and feet. The objective of this study was to describe the technical specificities and results of computed tomography (CT)-guided percutaneous laser photocoagulation in 15 patients with osteoid osteomas of the hands and feet. We retrospectively examined the medical charts of the 15 patients who were treated with CT-guided percutaneous laser photocoagulation therapy at our institution between 1994 and 2004. The 15 patients had a mean age of 24.33 years. None of them had received any prior surgical or percutaneous treatment for the osteoid osteoma. The follow-up period was 24 to 96 months (mean, 49.93). The pain resolved completely within 1 week. Fourteen patients remained symptom-free throughout the follow-up period; the remaining patient experienced a recurrence of pain after 24 months, underwent a second laser photocoagulation procedure, and was symptom-free at last follow-up 45 months later. No adverse events related to the procedure or to the location of the tumor in the hand or the foot were recorded. CT-guided percutaneous laser photocoagulation is an alternative to surgery for the treatment of osteoid osteomas of the hands and feet.     

Combined dynamic contrast-enhancement and serial 3D-subtraction analysis in magnetic resonance imaging of osteoid osteomas

The purpose of this study was to retrospectively correlate the results of dynamic contrast-enhanced magnetic resonance imaging (MRI) with histological and clinical diagnoses in patients with osteoid osteomas. Fifty-four patients with the MR diagnosis of osteoid osteoma were studied. MRI (1.5 Tesla) consisted of thin-section STIR sequences, dynamic 3D T1 gradient echo sequences during application of contrast material, and high-resolution postcontrast T1 spin echo sequences with fat saturation (maximum voxel size 0.6?×?0.6?×?3.0 mm). Evaluation was focused on serial image subtraction during the early phase after contrast injection and on time-intensity curves. The surrounding edema was helpful in finding the nidus in each lesion. In 49 of 54 patients (90.7%), the diagnosis of osteoid osteoma was certain or highly probable (sensitivity 1.0, positive predictive value 0.91). A total of 38 of 54 osteoid osteomas were histologically proven. Five MRI diagnoses were regarded as false positives. A similar proportion has been reported for computed tomography. Tailored high-resolution MR examinations with dynamic contrast enhancement can reliably diagnose osteoid osteomas and exactly localize the nidus without radiation exposure. We propose a stepwise approach with STIR sequences, dynamic contrast-enhanced scanning, and high-resolution postcontrast T1 spin echo sequences with fat saturation.