CT-guided percutaneous radiofrequency ablation of osteoid osteoma: Our experience in 87 patients

Abstract

Purpose:To evaluate the technical and clinical success of radiofrequency ablation of osteoid osteoma and analyze the factors responsible for clinical success. We also tried to investigate the role of follow-up computed tomography (CT) imaging.Materials and Methods:This is a prospective study approved by the institute's ethics committee involving 87 patients with appendicular osteoid osteoma. CT-guided radio frequency ablation was performed using a bipolar ablation system. Patients were followed up over 15.4 (4–24) months for pain, and clinical success/failure was determined using established criteria. Patients with clinical failure were taken for repeat ablation. Follow-up CT was obtained at 6 months and correlated with clinical success. Procedural scans were later reviewed for technical success in a blinded manner and correlated with clinical success along with other imaging and patient characteristics.Results:Mean pre-procedure visual analog scale (VAS) score was 7.0 ± 0.8. Primary success rate after single session was 86.2%(75/87 patients), and overall success rate after one/two sessions was 96.6%(84/87). No major complications were noted. Technical success rate was 89.7%(78/87). All 9 patients who had a suboptimal needle positioning had recurrence where as three patients had recurrence despite technical success. None of the imaging characteristics or history of prior intervention was significantly associated with clinical success. Follow-up CT showed advanced bone healing in 48 lesions, and was confined to the treatment success group. Alternately, minimal/absent bone healing was seen in all (12) patients of primary treatment failure and 27 patients with treatment success.Conclusions:CT-guided percutaneous radio frequency ablation is a safe and highly effective treatment for osteoid osteomas even in recurrent and residual cases. Technical success is the most important parameter affecting the outcome. Post radio frequency ablation CT findings have a good positive but a poor negative predictive value in prognostication.

The safety and the efficacy of computed tomography guided percutaneous radiofrequency ablation of osteoid osteoma

“…Percutaneous RFA-treatment is an outpatient procedure that does not require large dissections or bone excisions. This makes percutaneous interventional treatments advantageous 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 17, 18, 20, 21. Since the most of our patients were admitted from far-cities, we hospitalised them for one night for close follow-up of possible complications.…”

“…The median volume of the lesions was 185 mm 3 (min:22 mm 3 (7 × 3 x 2 mm); max:1123 mm 3 (15 × 12 × 12 mm)). In Pinto, Cagal and Vanderschueren's studies multiple probe usage was suggested for large lesions 7, 8, 22. Since the active tip part of the RFA probe we used was adjustable to 1, 1.5 and 2 cm, we were able to treat lesions of any sizes with single intervention.…”

“…Recent studies have shown that CT-guided percutaneous RFA is beneficial and may be preferred for treatment of OO 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14. The purpose of this study is to report the efficacy and safety of RFA-treatment in OO in a cohort of large number of cases.…”

Osteoid Osteoma: An Updated Review of Epidemiology, Pathogenesis, Clinical Presentation, Radiological Features, and Treatment Option

“…They found that 67% of the tumors developed in the proximal phalanx, 22% in the middle phalanx, and 11% in the metacarpal (21). The involvement of the skull and facial bones is exceptionally rare (22,23).…”

CT-guided radiofrequency ablation of osteoid osteoma: established concepts and new ideas

“…16 Contrast-enhanced CT and MRI although not necessary show enhancement of the unmineralised nidus and helps in increasing the diagnostic accuracy in indeterminate cases. 3 Dynamic CE MRI shows typical kinetic features of nidal enhancement and further helps in diagnosis and localisation of osteoid osteoma 17 (Figure 2e). Technetium (Tc) 99 bone scintigraphy findings of high central uptake with surrounding less uptake, commonly termed as "double density" sign, depicts nidus osteoblastic activity with associated host bone response.…”