Radiofrequency ablation of osteoid osteoma

Abstract

Osteoid osteoma is a benign bone neoplasm with a reported incidence of 2-3% among all bone primary tumors. Although it is a small and benign lesion, it is often cause of patient complaint and discomfort. It is generally characterized by a long lasting, unremitting pain that typically exacerbates at night, often leading to sleep deprivation and functional limitation of the skeletal segment involved, with a significant reduction of patient daily life activities and consequent worsening of the overall quality of life. Over decades, complete surgical resection has represented the only curative treatment for symptomatic patients. In the last years, new percutaneous ablation techniques, especially radiofrequency ablation, have been reported to be a safe and effective alternative to classical surgery, with a low complication and recurrence rate, and a significant reduction in hospitalization cost and duration. The aim of this article is to provide an overview about the radiofrequency thermal ablation procedure in the treatment of osteoid osteoma.

Keywords: Interventional radiology, Osteoid Osteoma, Bone tumors, Radiofrequency ablation.

Figure 1.

Osteoid osteoma of the proximal left femur. 6 year old female with left thigh pain of recent onset with no history of trauma. (A) Standard X-Ray shows wide cortical thickening of the medial portion of the proximal femoral diaphysis (arrow); radiolucent nidus is partially obscured by the surrounding reactive sclerotic bone. (B) MPR coronal view CT scan clearly demonstrates the presence of an oval shaped radiolucent nidus with some degree of calcification inside (arrowhead). (C) T2-weighted MRI image of the same lesion on the axial plane. (D) The lesion has been effectively treated with percutaneous radiofrequency thermal ablation

Figure 2.

Osteoid osteoma of the right femoral neck. 12 year old male suffering from right hip pain irradiated to the omolateral thigh for several months was referred to our center for percutaneous treatment of an osteoid osteoma of the femoral neck; note that in this location osteoid osteoma generally shows less or absent peripheral sclerosis. (A) Radiofrequency ablation was achieved via a posterior trans-gluteal approach. (B) Post-procedural control CT scan. (C) 30 days post-treatment MRI showing regular outcomes of intervention (arrow)

Figure 3.

Osteoid osteoma of the femur in elderly patient. 71 year old male with unremittent left thigh pain; osteoid osteoma was not clinically suspected, since it is quite uncommon in this age range. (A) CT scanogram demonstrating the presence of focal cortical thickening of the left femoral diaphysis. (B) Classical CT appearance of osteoid osteoma: central radiolucent nidus surrounded by sclerotic reactive bone. (C) Radiofrequency ablation was effective in achieving complete resolution of the symptoms

Figure 4.

Osteoid Osteoma of the tibia. 20 year old male with long-standing left knee pain. (A, B) Axial and coronal plane images showing an osteoid osteoma near the posterior surface of the left tibia. (C) Percutaneous radiofrequency thermal ablation of the lesion. (D) Volume-rendering reconstruction of the positioning of the inserting cannula

Fig. 5

Recurrence of osteoid osteoma after surgical curettage. 24 year old female complaining of persistent pain after surgical curettage of an osteoid osteoma of the scaphoid treated with bone graft from the distal radius. (A) Standard radiograph taken 3 months after the curettage shows the persistence of a radiolucent area at the distal pole of the right scaphoid (black arrow); missing bone from previous bone grafting (black arrowhead). (B) MRI confirmed the diagnosis of recurrence of osteoid osteoma (white arrow); note the outcomes of bone grafting from the distal radius (white arrowhead). (C-D) Radiofrequency ablation was the definitive treatment; wrist pain disappeared and no recurrence was observed.

Figure 6.

Osteoid osteoma of the talus. 39 year old male with recurrent left ankle pain. (A) CT scan demonstrates the presence of an osteoid osteoma of the talus (arrow). (B) Multiplanar reconstructions are used to guide the electrode inside the lesion. (C) 30 days post-treatment MRI showing regular thermal ablation outcomes (arrowhead)