Percutaneous Treatments of Benign Bone Tumors

Abstract

Benign bone tumors consist of a wide variety of neoplasms that do not metastasize but can still cause local complications. Historical management of these tumors has included surgical treatment for lesion resection and possible mechanical stabilization. Initial percutaneous ablation techniques were described for osteoid osteoma management. The successful experience from these resulted in further percutaneous image-guided techniques being attempted, and in other benign bone tumor types. In this article, we present the most common benign bone tumors and describe the available results for the percutaneous treatment of these lesions.

Keywords: benign bone tumor; cryoablation; interventional radiology; osteoid osteoma; radiofrequency ablation; vertebral hemangioma.

Fig. 1

A 32-year-old man with back pain caused by two osteoid osteomas of the right upper articular process of L1. Axial ( a ) and oblique ( b ) unenhanced CT scan identifies two round dense niduses ( white arrows ) surrounded by thickened cortical reaction. Note the induced arthritis of the adjacent joint. ( c ) axial fat-suppressed T1-weighted contrast-enhanced MR image demonstrates early intense contrast enhancement of the two niduses ( white arrows ). ( d ) Axial prone per-procedure CT scan shows the position of a laser fiber in the nidus.

Fig. 2

A 35-year-old woman with upper back pain due to an aggressive vertebral hemangioma of Th5. ( a ) Axial unenhanced CT scan shows an aggressive vertebral hemangioma of T5 with typical sparse and coarsened vertebral trabeculae. ( b, c ) Axial and sagittal fat-suppressed T1-weighted contrast-enhanced MR images identify a large extraosseous and epidural component ( white arrows ) leading to a severe thoracic canal stenosis. ( d ) Axial unenhanced intraprocedural CT scan shows the position of an 18-gauge needle in the vertebral body. ( e ) Axial intraprocedural CT scan during a venogram identifies the extensive vascularity of the hemangioma inside the vertebra and the surrounding soft tissue ( arrows ). ( f ) Postprocedure sagittal CT scan demonstrates cement filling the vertebral body.

Fig. 3

A 28-year-old man with persistent back pain caused by fibrous dysplasia of the spinous process of T11. ( a, b ) Unenhanced sagittal T1- and T2-weighted MR images demonstrate fibrous dysplasia of T11 as a hypo-T1 hyper-T2 lesion ( white arrows ) of the spinous process. ( c ) Axial unenhanced CT scan of T11 shows endosteal scalloping, opaque ground-glass abnormal bone, and a peripheral thick reactive bone. ( d ) Postprocedure CT scan demonstrates cement filling the lytic portion of the fibrous dysplasia.