Paediatric musculoskeletal interventional radiology

Abstract

Interventional radiology technique is now well established and widely used in the adult population. Through minimally invasive procedures, it increasingly replaces surgical interventions that involve higher percentages of invasiveness and, consequently, of morbidity and mortality. For these advantageous reasons, interventional radiology in recent years has spread to the paediatric age as well. The aim of this study was to review the literature on the development, use and perspectives of these procedures in the paediatric musculoskeletal field. Several topics are covered: osteomuscle neoplastic malignant and benign pathologies treated with invasive diagnostic and/or therapeutic procedures such as radiofrequency ablation in the osteoid osteoma; invasive and non-invasive procedures in vascular malformations; treatment of aneurysmal bone cysts; and role of interventional radiology in paediatric inflammatory and rheumatic inflammations. The positive results that have been generated with interventional radiology procedures in the paediatric field highly encourage both the development of new ad hoc materials, obviously adapted to young patients, as well as the improvement of such techniques, in consideration of the fact that childrens' pathologies do not always correspond to those of adults. In conclusion, as these interventional procedures have proven to be less invasive, with lower morbidity and mortality rates as well, they are becoming a viable and valid alternative to surgery in the paediatric population.

Figure 1.

A 2-year-old girl with left tibial pain and lameness. (a–c) Typical findings of osteoid osteoma of left tibia on radiographic, scintigraphic and CT images. (d, e) CT-guided biopsy and radiofrequency ablation of the lesion. (f) Needle tract within the lesion on post-procedure CT scan.

Figure 2.

A 7-year-old boy with lumbar pain. (a–c) Lumbar spine osteoid osteoma with soft tissues inflammatory oedema on MR, CT and scintigraphic images. (d) CT-guided radiofrequency ablation of the lesion.

Figure 3.

An 8-year-old girl with left supraclavicular swelling. (a) Large osteolytic aneurysmal bone cyst of the left clavicula. (b) Fluoroscopic-guided sclerotherapy of the lesion. (c, d) Progressive ossification of the bone in 2-year follow-up.

Figure 4.

A 6-year-old boy with pathological fracture of the left homerus. (a, b) Metadiaphyseal humerus aneurysmal bone cyst on radiographic and MR images. (c) Sclerotherapy of the lesion performed with the “double-needle” technique. (d) Remodelled bone at 2-year follow-up.

Figure 5.

A 9-year-old girl with venous malformation of the left distal medial vastus muscle extended to the soft tissues of the suprapatellar region. MR images (a–c) and ultrasound Doppler (d, e) of the venous malformation with ectatic venous vessels and phleboliths. (f) Phlebography shows deep femoral vein drainage. Sclerotherapy was performed after tourniquet positioning.

Figure 6.

A 14-year-old boy with troncular arteriovenous malformation of the right arm. CT (a) and digital subtraction angiographic images (b–d) show multiple aneurysms of the humeral artery and arteriovenous fistula within the lesion. Selective catheterism (d, e) and the embolization with glue (f) of a fistula.

Figure 7.

A 13-year-old girl with back pain, without fever and normal laboratory tests. (a, b) MR and scintigraphic images of the spine show multiple vertebral deformities. (c, d) CT scans show focal osteolysis of the superior plate in L1 (first lumbar vertebra). (e, f) CT-guided biopsy was performed in the suspect of histiocytosis. The final diagnosis was chronic recurrent multifocal osteomyelitis.

Figure 8.

A 2-year-old boy with left coxal pain and claudication. (a, b) Plain film and CT scan show lytic lesion of the left femoral neck. (c) T₁ weighted fat-sat post-gadolinium MR image shows enhancement within the lesion. (d) Fluoroscopic-guided biopsy allowed the diagnosis of chronic recurrent multifocal osteomyelitis.