Needleless Ablation of Osteoid Osteoma and Osteoblastoma: The Emergent Role of MRgFUS

Abstract

Osteoblastoma (OB) and osteoid osteoma (OO) are benign bone-forming tumors, with nearly identical basic microscopic features. The main difference is dimension (OO has usually a nidus measuring <2 cm in diameter). In addition, OB is biologically more active than OO, with a tendency to grow in size. Historically, treatments have included surgical resection and analgesics, although invasiveness and poor tolerance have led to the current standard of care moving toward interventional radiology, where radiofrequency ablation (RFA) represents the most diffuse technique. Magnetic resonance-guided focused ultrasound surgery (MRgFUS) has recently emerged as another innovative alternative treatment, providing tumor ablation through a needleless and ionizing radiation-free modality. In addition, this technique has the ability to guarantee a very precise and controlled increase in temperature, delivering small amounts of energy that can accurately destroy only the lesion, avoiding healthy surrounding tissues. The present review focuses on MRgFUS as the less invasive, safe, effective, and durable treatment option for the management of osteoid osteoma and osteoblastoma, including a description of technical details, indications and outcomes.

Osteoid osteoma of the distal radius presenting as an inconspicuous swelling in a young child

“…MR-guided focused ultrasound ablation therapy is a newer non-invasive radiological method with little damage to nearby neurovascular structures and skin 24 25. Arthroscopic surgical excision of the nidus has also been tried and reported, with advantages of clear tumour visualisation and minimal invasion 26–28.…”

Intra‐articular Osteoid Osteoma of the Intermediate Cuneiform Bone Causing Articular Degeneration: A Rare Case and Literature Review

“…The installation of 10% dextrose solution in the subcutaneous plane or the joint cavity may be beneficial 22 . Furthermore, MR‐guided focused ultrasound ablation therapy (MRgFUS) emerges as a new non‐invasive radiology revolution with little damage to the neurovascular bundle or articular cartilage 23–25 . In addition, relatively large lesions measuring >1 cm in size might have higher odds of recurrence 26,27 .…”

“… 22 Furthermore, MR‐guided focused ultrasound ablation therapy (MRgFUS) emerges as a new non‐invasive radiology revolution with little damage to the neurovascular bundle or articular cartilage. 23 , 24 , 25 In addition, relatively large lesions measuring >1 cm in size might have higher odds of recurrence. 26 , 27 The use of a multi‐pronged probe or multiple probe placements is recommended.…”

Interventional Imaging Techniques as Alternative to Surgery of the Foot and Ankle

“…The technique creates a precise and controlled temperature increase, delivering small amounts of energy to accurately destroy lesions while avoiding healthy surrounding tissues. 43 Although promising results have been noted regarding osteoid osteomas and osteoblastomas, the technique is only available in certain specialized centers, remains expensive, and is yet to be confirmed with large randomized controlled long-term outcome data.…”