Magnetic resonance-guided focused ultrasound surgery treatment of non-spinal intra-articular osteoblastoma: feasibility, safety, and outcomes in a single-center retrospective analysis

Abstract

Background: Interventional radiology, thanks to its low invasiveness and possibility to reduce the average time for the patients to come back to their normal activity, is becoming more and more promising and diffused in multiple fields. Employed without needles, MRgFUS is probably the less invasive techniques among the ones belonging to the field of interventional radiology. Purpose: To evaluate safety and effectiveness of MRgFUS in the treatment of a rare and benign, though disabling, bone lesion: intra-articular osteoblastoma. Materials and methods: A retrospective study was carried out on 6 patients (mean, 21 years) treated in the last 2 years with MRgFUS for symptomatic, histologically proved intra-articular osteoblastoma. The main inclusion criterion was the presence of a good acoustic window. The procedures consisted in MR-guided ablation, using high intensity ultrasound beams focused on the target lesion. Spinal anesthesia or peripheral nerve block was used. Clinical (based on pain and functional scales) and imaging follow-up studies were performed up to 1 year after treatment. Complications were recorded. Multiple linear regression and analysis of variance were used to assess correlations. Results: All the procedures were technically successful; no complications were observed. Painful symptomatology decreased of 88% at 6 months and 98% at 12 months (p < 0.0001), and was associated to functional improvement (p ¼ 0.002). MRI and CT controls showed disappearance of all signs of disease and bone inflammation with a marked tendency to bone healing. Conclusion: This study shows the safety and effectiveness of MRgFUS in the treatment of intra-articular osteoblastoma with a good acoustic window.

Musculoskeletal Interventional Radiology in the Pediatric Population: State of the Art

“…CT-guided RFA is acceptable as a valid option for the treatment of OB, even when it is localized in the spine, where, if necessary, thermal protection techniques are used. 29,36,37 The procedure is similar to that used for the treatment of OO, but the area of ablation is usually greater. Moreover, particular accuracy is needed to avoid damaging the sensitive structures of the spine.…”

“…A valid alternative to RFA in the treatment of OB is MRgFUS, reported to have high rates of success similar to RFA and complication rates 37 with the limitations intrinsic to the technique previously described.…”

Osteoblastoma: When the Treatment Is Not Minimally Invasive, an Overview

“…For OBL, due to its greater size, surgery still plays an important role, even if thermoablation and Hifu can be considered case by case, especially for small lesions [13,14].…”

“…Indeed, Arrigoni et all, in 2018, published a series of 11 patients affected by OBL of the spine who underwent radiofrequency ablation, obtaining total relief in all cases [14]; the same group, two years later, presented six cases of intrarticular OBL successfully treated with Hifu without any complications [13].…”

<p>Experimental Study of Tumor Therapy Mediated by Multimodal Imaging Based on a Biological Targeting Synergistic Agent</p>

“…As a new noninvasive tumor treatment technology, high-intensity focused ultrasound (HIFU) has been widely used in the treatment of solid tumors and has broad application prospects. [1][2][3][4][5][6][7] The therapeutic principle of HIFU is similar to that of a magnifying glass focusing light. 8 Briefly, the HIFU technique utilizes high-energy focusing devices, which focus multiple low-energy ultrasound beams on the target tumor in a certain way to induce thermal, cavitation and mechanical effects, which can cause irreversible coagulative necrosis, finally achieving therapeutic effects.…”