1
|
Bedoya MA, Iwasaka-Neder J, Tsai A, Bixby SD. Intra-articular Osteoid Osteomas: Imaging Manifestations and Mimics. Radiographics 2024; 44:e230208. [PMID: 38843097 DOI: 10.1148/rg.230208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
Osteoid osteoma (OO) is the third most prevalent benign bone neoplasm in children. Although it predominantly affects the diaphysis of long bones, OO can assume an intra-articular location in the epiphysis or the intracapsular portions of bones. The most common location of intra-articular OO is the hip joint. The presentation of intra-articular OOs often poses a diagnostic enigma, both from clinical and radiologic perspectives. Initial symptoms are often vague and nonspecific, characterized by joint pain, stiffness, and limited range of motion, which frequently contributes to a delayed diagnosis. Radiographic findings range from normal to a subtle sclerotic focus, which may or may not have a lucent nidus. In contrast to their extra-articular counterparts, intra-articular lesions have distinct features at MRI, including synovitis, joint effusion, and bone marrow edema-like signal intensity. While CT remains the standard for identifying the nidus, even CT may be inadequate in visualizing it in some cases, necessitating the use of bone scintigraphy or fluorine 18-labeled sodium fluoride PET/CT for definitive diagnosis. Radiologists frequently play a pivotal role in suggesting this diagnosis. However, familiarity with the unique imaging attributes of intra-articular OO is key to this endeavor. Awareness of these distinctive imaging findings of intra-articular OO is crucial for avoiding diagnostic delay, ensuring timely intervention, and preventing unnecessary procedures or surgeries resulting from a misdiagnosis. The authors highlight and illustrate the different manifestations of intra-articular OO as compared with the more common extra-articular lesions with respect to clinical presentation and imaging findings. ©RSNA, 2024 Supplemental material is available for this article.
Collapse
Affiliation(s)
- M Alejandra Bedoya
- From the Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115
| | - Jade Iwasaka-Neder
- From the Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115
| | - Andy Tsai
- From the Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115
| | - Sarah D Bixby
- From the Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115
| |
Collapse
|
2
|
Bhakhar A, Sharma A, Kaganur R, Pragadeeshwaran J, Paul N, Kumar Dhukia R, Bagarhatta M, Joshi N, Mor A, Sachdeva A. Outcomes of Osteoid Osteoma Treated by Percutaneous CT-Guided Radiofrequency Ablation. Cureus 2023; 15:e42675. [PMID: 37649955 PMCID: PMC10463101 DOI: 10.7759/cureus.42675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2023] [Indexed: 09/01/2023] Open
Abstract
Introduction Osteoid osteomas are the most frequent true benign bone tumor in the adolescent age group and the third most prevalent benign bone tumor overall. This study was designed to assess the effectiveness of the procedure and correlate it with the analgesia offered because of the significant burden of this illness and new literature supporting the successful outcomes of image-guided percutaneous radiofrequency ablation (RFA) in osteoid osteoma. Methodology This hospital-based interventional trial was carried out in a tertiary care referral center. Forty-two patients with osteoid osteoma, ranging in age from 9 to 30, were included in the study. The patients received RFA guided by computed tomography (CT), and they were postoperatively monitored at one, two, and four weeks and three, six months, and 12 months. A numerical pain scale (NPS) was used to evaluate the patient's pain both before and after the procedure. The preoperative and postoperative results were contrasted. Results A total of 42 participants were enrolled in the study. Eight (19.05%) women and 34 (80.95%) men made up the group. Complete pain alleviation (NPS=0) was attained in 42.8% and 96.4% of the study group in the first and second weeks post-procedure. Almost all patients began protected weight-bearing at one week, according to their level of pain tolerance. Osteoid osteoma of the talus was a remnant lesion in one patient that required further treatment after two weeks. During the duration of the follow-up, no problems were recorded. Conclusion Percutaneous CT-guided RFA of osteoid osteoma is a safe, minimally invasive procedure and greatly reduces the duration of hospitalization. It has excellent functional outcomes and no known complications.
Collapse
Affiliation(s)
- Anurag Bhakhar
- Department of Trauma Surgery and Critical Care, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Ajay Sharma
- Department of Trauma Surgery and Critical Care, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Raghavendra Kaganur
- Department of Orthopaedics, All India Institute of Medical Sciences, Patna, Patna, IND
| | - J Pragadeeshwaran
- Department of Trauma Surgery and Critical Care, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Nirvin Paul
- Department of Trauma Surgery and Critical Care, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Rakesh Kumar Dhukia
- Department of Orthopaedics, SMS (Sawai Man Singh) Medical College, Jaipur, IND
| | - Meenu Bagarhatta
- Department of Radiodiagnosis, SMS (Sawai Man Singh) Medical College, Jaipur, IND
| | - Narendra Joshi
- Department of Orthopaedics, SMS (Sawai Man Singh) Medical College, Jaipur, IND
| | - Amit Mor
- Department of Orthopaedics, Post Graduate Institute of Medical Sciences, Pandit Bhagwat Dayal Sharma University of Health Sciences, Rohtak, IND
| | - Aman Sachdeva
- Department of Preventive Medicine, Post Graduate Institute of Medical Sciences, Pandit Bhagwat Dayal Sharma University of Health Sciences, Rohtak, IND
| |
Collapse
|
3
|
Papalexis N, Peta G, Ponti F, Tuzzato G, Colangeli M, Facchini G, Spinnato P. CT-Guided Radiofrequency Thermal Ablation for the Treatment of Atypical, Early-Onset Osteoid Osteoma in Children Younger than 4 Years Old: Single-Institution Experience and Literature Review. Diagnostics (Basel) 2022; 12:diagnostics12112812. [PMID: 36428872 PMCID: PMC9689092 DOI: 10.3390/diagnostics12112812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/10/2022] [Accepted: 11/13/2022] [Indexed: 11/18/2022] Open
Abstract
The aim of our study is to report our experience on CT-guided radiofrequency ablation (RFA) for osteoid osteoma (OO) in children under 4 years of age and to review the literature regarding this atypical, early onset of the disease. We retrospectively reviewed the clinical and radiological records of the patients treated with CT-guided RFA for OO at our institution (2006−2021), including those under 4 years of age. Data regarding technical success, clinical success, and biopsy diagnostic yield were collected. Moreover, we performed a literature review including previous articles on early-onset OO. We found only 12 patients that were under 4 years of age (12/842−1.4%) at the time of RFA treatment: 4 F and 8 M, mean age at the time of the treatment 35.3 months (range 22−46 months). The mean follow-up was 22.8 months (range 6−96 months). Technical success was achieved in all cases (12/12). In all patients (12/12), a complete remission of the pain symptoms was achieved at clinical follow-up controls. No recurrence of pain or complications were documented. The histopathological diagnosis was confirmed in 4 patients (4/12−33.3%). Moreover, we found another 9 articles in the literature with a main focus on early-onset OO (<4 years old), with a total of 12 patients included; 6 of those patients (6/12−50%) were treated with CT-guided RFA, with success reported 5 cases (5/6−83.3%). Our series of cases treated at a single institution, together with the existing data from the literature, confirms that CT-guided RFA is effective and safe for the treatment of osteoid osteoma, even in atypical, early onset in children under 4 years of age.
Collapse
Affiliation(s)
- Nicolas Papalexis
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Giuliano Peta
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Federico Ponti
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Gianmarco Tuzzato
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Marco Colangeli
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Giancarlo Facchini
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Paolo Spinnato
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
- Correspondence: or
| |
Collapse
|
4
|
Tepelenis K, Skandalakis GP, Papathanakos G, Kefala MA, Kitsouli A, Barbouti A, Tepelenis N, Varvarousis D, Vlachos K, Kanavaros P, Kitsoulis P. Osteoid Osteoma: An Updated Review of Epidemiology, Pathogenesis, Clinical Presentation, Radiological Features, and Treatment Option. In Vivo 2021; 35:1929-1938. [PMID: 34182465 DOI: 10.21873/invivo.12459] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 12/12/2022]
Abstract
Osteoid osteoma, the third most common benign bone tumor, usually occurs in the cortex of long bones. It consists of a radiolucent nidus surrounded by reactive osteosclerosis. Generally, osteoid osteoma affects young males. Nocturnal pain that eases with salicylates or nonsteroidal anti-inflammatory drugs (NSAID) is the typical clinical presentation. Sometimes, it remains undiagnosed for a long time. Plain radiography and computed tomography are usually sufficient for the diagnosis of osteoid osteoma. Initial treatment includes salicylates and NSAID because the tumor often regresses spontaneously over 2-6 years. Surgical treatment is indicated in case of unresponsive pain to medical therapy, no tolerance of prolonged NSAID therapy due to side effects, and no willingness to activity limitations. Nowadays, minimally invasive techniques have replaced open surgery and are considered the gold standard of surgical treatment. Although cryoablation seems superior in terms of the nerve damage and immunotherapy effect, radiofrequency ablation is the preferred technique.
Collapse
Affiliation(s)
- Kostas Tepelenis
- Department of Surgery, University Hospital of Ioannina, Ioannina, Greece;
| | - Georgios P Skandalakis
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York City, NY, U.S.A
| | | | | | | | - Alexandra Barbouti
- Anatomy - Histology - Embryology, University of Ioannina, Ioannina, Greece
| | | | | | | | | | | |
Collapse
|
5
|
Ishikura Y, Yoshida R, Yoshizako T, Kishimoto K, Ishikawa N, Maruyama R, Kitagaki H. Osteoid osteoma of the rib with strong F-18 fluoro-deoxyglucose uptake mimicking osteoblastoma: a case report with literature review. Acta Radiol Open 2021; 10:20584601211022497. [PMID: 34158972 PMCID: PMC8182198 DOI: 10.1177/20584601211022497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 05/17/2021] [Indexed: 11/17/2022] Open
Abstract
Osteoid osteoma is a benign osteoblastic bone lesion, characterized by nocturnal pain
alleviated by salicylates or nonsteroidal anti-inflammatory drugs. This tumor distinctly
affects the long bones, typically the femur or tibia and is rarely located in the ribs.
Usually, this tumor is usually diagnosed by computed tomography or magnetic resonance
imaging, but F-18 fluoro-deoxyglucose positron emission tomographic (FDG-PET)/computed
tomography is usually negative and is not used for diagnosis. We recently encountered a
case of an osteoid osteoma located in the rib of 44-year-old Asian male with strong FDG
uptake as high as 12.0 at the maximum standardized uptake value at FDG-PET/computed
tomography. His computed tomography and magnetic resonance imaging showed osteosclerosis,
bone marrow edema, and edema of surrounding tissues not only in the bone with nidus but
also in the adjacent bone, and pathological findings showed strong infiltration munched
radiology. Strong FDG uptake mimicking osteoblastoma. Osteoid osteoma with strong FDG
uptake suggested a strong inflammatory response.
Collapse
Affiliation(s)
- Yuka Ishikura
- Department of Radiology, Faculty of Medicine, Shimane University, Shimane,
Japan
- Yuka Ishikura, Department of Radiology, Faculty of
Medicine, Shimane University, 89-1, Enya-cho, Izumo, Shimane 693-8501, Japan.
| | - Rika Yoshida
- Department of Radiology, Faculty of Medicine, Shimane University, Shimane,
Japan
| | - Takeshi Yoshizako
- Department of Radiology, Faculty of Medicine, Shimane University, Shimane,
Japan
| | - Kouji Kishimoto
- Department of Respiratory Surgery, Faculty of Medicine, Shimane
University, Shimane, Japan
| | - Noriyoshi Ishikawa
- Department of Organ Pathology, Faculty of Medicine, Shimane University,
Shimane, Japan
- Department of Pathology, Faculty of Medicine, Shonan Fujisawa Tokushukai
Hospital, Fujisawa, Japan
| | - Riruke Maruyama
- Department of Organ Pathology, Faculty of Medicine, Shimane University,
Shimane, Japan
| | - Hajime Kitagaki
- Department of Radiology, Faculty of Medicine, Shimane University, Shimane,
Japan
| |
Collapse
|
6
|
Wacheul E, Leemrijse T, Galant C, Malghem J, Lecouvet FE. Soft tissue recurrence of an osteoid osteoma: an exceptional observation. Skeletal Radiol 2021; 50:827-833. [PMID: 32964242 DOI: 10.1007/s00256-020-03609-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 09/01/2020] [Accepted: 09/10/2020] [Indexed: 02/02/2023]
Abstract
We report the observation of the soft tissue recurrence of an osteoid osteoma (OO) in a 26-year-old man initially complaining of post-traumatic pain and swelling of the right ankle. A first arthroscopic resection was performed after the misdiagnosis of "bone irregularities" observed on computed tomography (CT) and magnetic resonance imaging (MRI). The diagnosis of OO was made by histological analysis of the resection material. The patient became asymptomatic for 5 years until the symptoms progressively recurred. Follow-up MRI and CT studies demonstrated a nodular bony focus within the periarticular soft tissues of the ankle. The lesion was removed, and histological analysis confirmed the diagnosis of a whole viable OO. This observation likely resulted from the displacement of the initial lesion during the initial arthroscopic procedure. This case report highlights the possibility of recurrence of OO in the soft tissues.
Collapse
Affiliation(s)
- Emilie Wacheul
- Department of Pathology, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCLouvain), Avenue Hippocrate, 10, 1200, Brussels, Belgium
| | | | - Christine Galant
- Department of Pathology, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCLouvain), Avenue Hippocrate, 10, 1200, Brussels, Belgium
| | - Jacques Malghem
- Department of Radiology, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCLouvain), 10 Avenue Hippocrate, 10/2942, 1200, Brussels, Belgium
| | - Frédéric E Lecouvet
- Department of Radiology, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCLouvain), 10 Avenue Hippocrate, 10/2942, 1200, Brussels, Belgium.
| |
Collapse
|
7
|
Cazzato RL, Garnon J, De Marini P, Auloge P, Dalili D, Koch G, Antoni D, Barthelemy P, Kurtz JE, Malouf G, Feydy A, Charles YP, Gangi A. French Multidisciplinary Approach for the Treatment of MSK Tumors. Semin Musculoskelet Radiol 2020; 24:310-322. [DOI: 10.1055/s-0040-1710052] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
AbstractSeveral interventional treatments have recently been integrated into the therapeutic armamentarium available for the treatment of bone tumors. In some scenarios (e.g., osteoid osteoma), interventional treatments represent the sole and definitive applied treatment. Due to the absence of widely shared protocols and the complex multivariate scenarios underlying the clinical presentation of the remaining bone tumors including metastases, therapeutic strategies derived from a multidisciplinary tumor board are essential to provide effective treatments tailored to each patient. In the present review, we present the multidisciplinary therapeutic strategies commonly adopted for the most frequent bone tumors.
Collapse
Affiliation(s)
- Roberto Luigi Cazzato
- Service d’Imagerie Interventionnelle, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Julien Garnon
- Service d’Imagerie Interventionnelle, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Pierre De Marini
- Service d’Imagerie Interventionnelle, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Pierre Auloge
- Service d’Imagerie Interventionnelle, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Danoob Dalili
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Nuffield Orthopaedic Centre, Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom
| | - Guillaume Koch
- Service d’Imagerie Interventionnelle, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Delphine Antoni
- Service de Radiothérapie, Institut de cancérologie Strasbourg Europe (ICANS), Strasbourg, France
| | - Philippe Barthelemy
- Service d’Oncologie Médicale, Institut de cancérologie Strasbourg Europe (ICANS), Strasbourg, France
| | - Jean Emmanuel Kurtz
- Service d’Oncologie Médicale, Institut de cancérologie Strasbourg Europe (ICANS), Strasbourg, France
| | - Gabriel Malouf
- Service d’Oncologie Médicale, Institut de cancérologie Strasbourg Europe (ICANS), Strasbourg, France
| | - Antoine Feydy
- Service de Radiologie, Hôpital Cochin, APHP, Université Paris V, Paris, France
| | - Yan-Philippe Charles
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle (FMTS), Université de Strasbourg, Strasbourg, France
| | - Afshin Gangi
- Service d’Imagerie Interventionnelle, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| |
Collapse
|
8
|
Acetabula Osteoid Osteoma Mimicking Juvenile Idiopathic Arthritis and Chronic Recurrent Multifocal Osteomyelitis. Case Rep Rheumatol 2020; 2020:8810735. [PMID: 32908769 PMCID: PMC7474778 DOI: 10.1155/2020/8810735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/06/2020] [Indexed: 11/19/2022] Open
Abstract
Osteoid osteoma (OO) is a benign bone tumor that usually presents between 10 and 35 years of age. The metaphysis and diaphysis of the femur and tibia are the typical locations. The diagnosis is usually straightforward when images reveal a radiolucent nidus surrounded by reactive sclerosis. However, the diagnosis is more difficult when it occurs at atypical locations with nonspecific and misleading appearance on images. OO may mimic juvenile idiopathic arthritis (JIA), bone infection, or malignancy. We present a 14-year-old male with a 4-month history of left hip pain. His pain was worse with playing hockey and lacrosse and in the morning and sometimes woke him up at night. His examination was significant for pain with flexion and external rotation of the left hip and for mild limitation of full external rotation. Blood work revealed normal complete blood count, erythrocyte sedimentation rate, and C-reactive protein. Left hip X-ray was unremarkable. Left hip MR arthrogram showed marked edema of the medial and posterior walls of the left acetabulum. CT-guided biopsy of the left acetabulum showed unremarkable flow cytometry and chronic inflammatory component raising concern about chronic recurrent multifocal osteomyelitis (CRMO). Bone scan revealed focal increased uptake in the left acetabulum and no additional abnormality. Repeat MRI with intravenous contrast showed a left hip effusion, focal synovial enhancement in the medial left hip, and acetabula edema. The patient failed treatment for presumed JIA and CRMO with nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, methotrexate, and adalimumab. CT scan of the left hip was performed for further evaluation of the bone and showed 11 × 6 mm low attenuation focus with subtle internal nidus in the posteromedial aspect of the acetabular rim, suggestive of intra-articular OO. Radiofrequency ablation was performed with no complications, and the left hip pain improved. The atypical location resulted in delay of diagnosis for 12 months after presentation. We highlight the diagnostic pitfalls observed in atypical OO locations and the difficulties this creates with making the diagnosis. OO mimicking JIA has previously been described. We submit CRMO as another differential diagnosis which may be mimicked and demonstrate the vital role of CT scan in the diagnosis.
Collapse
|
9
|
Gomes AR, Quatrin FY, Becker NM, Zanella RC, Rocha TMS. Resection of Bone Tumor Guided by Gamma Probe and Evaluation of Postoperative Pain. Rev Bras Ortop 2020; 55:115-120. [PMID: 32123456 PMCID: PMC7048569 DOI: 10.1055/s-0039-1700818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 10/30/2018] [Indexed: 11/24/2022] Open
Abstract
Osteoid osteoma is a benign neoplasm commonly found in young men, but that can be found in every age, which affects mainly long bones, clinically characterized by continuous and limiting pain that is relieved by salicylates. It is a small lesion composed of immature osteoid tissue, central hypervascularization and surrounding sclerotic area. Its diagnosis is performed by the clinic and aided by imaging tests, such as common radiography and computed tomography. Radiography shows a central radiolucent lesion and peripheral sclerosis. The biopsy takes place only in cases of diagnostic doubt. Surgical treatment involves resection of the niche, providing greater symptomatic relief, as well as percutaneous techniques. The technique of radioisotope-guided resection has good acceptance in the scientific community for its fast surgical procedure directed to the lesion; however, the percutaneous technique that stands out is radiofrequency ablation. In the present study, all of the patients submitted to the technique presented total improvement of the pain.
Collapse
Affiliation(s)
- Alberto Ramos Gomes
- Onco-ortopedia, Fundação Hospitalar de Blumenau, Hospital Santo Antônio, Blumenau, SC, Brasil
| | - Felipe Younes Quatrin
- Departamento de Ortopedia e Traumatologia, Hospital Santo Antônio, Blumenau, SC, Brasil
| | - Nadiane Maciel Becker
- Departamento de Ortopedia e Traumatologia, Hospital Santo Antônio, Blumenau, SC, Brasil
| | - Ruan Carlo Zanella
- Departamento de Ortopedia e Traumatologia, Hospital Santo Antônio, Blumenau, SC, Brasil
| | | |
Collapse
|
10
|
Osteoid Osteoma in Children Younger than 3 Years of Age. Case Rep Orthop 2019; 2019:8201639. [PMID: 31583150 PMCID: PMC6754966 DOI: 10.1155/2019/8201639] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 07/30/2019] [Accepted: 08/31/2019] [Indexed: 11/18/2022] Open
Abstract
We present a case series of four children, younger than 3 years old, with osteoid osteoma of the lower limb. Pain and limping were the main symptoms. With careful clinical examination, we could localize the affected area. Radiological evaluation revealed cortical thickening in 3 children. On MRI examination, we found extensive edema, with normal bony cortices. The central nidus was found in 3 children. CT scan was the most accurate examination which revealed the central nidus with surrounding sclerosis. Bone scans had positive uptake in the affected area. Our patients were treated with an intralesional excision biopsy, with simultaneous radiofrequency ablation in those affected in the femur. Pathological specimens confirmed the diagnosis of osteoid osteoma. There was uneventful recovery of our patients. This case series contributes to the limited description of osteoid osteoma diagnosed and treated in very young children.
Collapse
|
11
|
Higuchi T, Yamamoto N, Hayashi K, Takeuchi A, Abe K, Taniguchi Y, Araki Y, Tsuchiya H. C-arm cone-beam computed tomography-guided minimally invasive open excision of an osteoid osteoma undetectable on fluoroscopy: A case report. Int J Surg Case Rep 2019; 61:14-19. [PMID: 31306900 PMCID: PMC6626976 DOI: 10.1016/j.ijscr.2019.06.062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 06/26/2019] [Accepted: 06/28/2019] [Indexed: 11/15/2022] Open
Abstract
A robotic C-arm cone-beam computed tomography (CBCT) system provides a clear intraoperative visualization of the osteoid osteoma. C-arm CBCT allowed precise access to the tumor, accurate tumor resection, and minimal sacrifice of the normal bone in osteoid osteoma surgery. Repurpose use of the dilator, retractor, and wider trephine tips achieved more conservative results with a smaller skin incision.
Introduction The small size of a nidus and the extensive sclerosis around it often make it difficult to identify tumors from the surrounding normal bone by fluoroscopy, and a large amount of bone resection might be required to secure complete removal during osteoid osteoma surgery. In this report, we present the first case of radiographically invisible osteoid osteoma that was successfully resected under a robotic C-arm cone-beam computed tomography (CBCT) imaging system. Presentation of case A 14-year-old boy presented with persistent pain around the left knee joint was diagnosed with osteoid osteoma of the left distal femur. Since the tumor was not detectable by intraoperative fluoroscopy, a CBCT system was used for guidance during an open tumor resection. For a less invasive surgery, we repurposed the dilator and retractor of the microendoscopic discectomy (MED) system and resected the tumor using the wider trephine tips for bone biopsy. At the final follow-up one year later, the function of the afflicted limb was normal with no complaint of any symptoms. Plain radiograph at the final follow-up showed new bone formation completely filling the bone defect, without local recurrence. Discussion CBCT allowed for clear intraoperative visualization of the osteoid osteoma, thereby promising a secure resection and less invasive osteoid osteoma treatment. Furthermore, the repurposed use of the dilator and retractor of the MED system as well as the wider trephine tips for bone biopsy made the procedure less invasive. Conclusion CBCT-guided minimally invasive open excision surgery could be a useful option for the management of radiographically invisible osteoid osteoma.
Collapse
Affiliation(s)
- Takashi Higuchi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Norio Yamamoto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Katsuhiro Hayashi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Akihiko Takeuchi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Kensaku Abe
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Yuta Taniguchi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Yoshihiro Araki
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.
| |
Collapse
|
12
|
Osteoid osteoma: multimodality imaging with focus on hybrid imaging. Eur J Nucl Med Mol Imaging 2018; 46:1019-1036. [PMID: 30341641 DOI: 10.1007/s00259-018-4181-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 09/25/2018] [Indexed: 02/08/2023]
Abstract
Osteoid osteoma is a painful, benign, osteoblastic lesion that occurs in younger patients and affects the extremities or the axial skeleton. While plain film findings may suggest the diagnosis, in complex anatomical regions such as the spine, pelvis, wrist and foot advanced imaging modalities are often required. A typical nidus surrounded by sclerosis or cortical thickening characterizes osteoid osteoma on plain radiography and CT. MR is the cross-sectional imaging modality of choice for most musculoskeletal disorders. Unfortunately, extensive accompanying bone marrow oedema, soft-tissue alterations, difficulty detecting the nidus, and lesion locations close to a joint (with reactive arthritis) may make a confident diagnosis of osteoid osteoma by MR imaging difficult. Hybrid imaging with bone-seeking tracers such as SPECT/CT with 99mTc-labelled bisphosphonates or PET/CT with 18F-labelled sodium fluoride (18F-NaF) combines high radionuclide uptake with morphological details and provides accurate diagnosis of osteoid osteoma and additional information for treatment planning. FDG is not the recommended PET tracer because osteoid osteoma is normally FDG-negative, although some osteoid osteomas may show increased FDG uptake. Osteoblastoma, Brodie's abscess and stress fractures may mimic osteoid osteoma on imaging and clinical presentation. Once identified as the pain generator, destruction of the osteoid osteoma nidus by ablation or resection techniques usually leads to complete healing. Image-guided drill excision and radiofrequency ablation are widely used interventions. We review the presentation of osteoid osteoma across all imaging modalities, with special focus on hybrid imaging techniques.
Collapse
|
13
|
De Filippo M, Russo U, Papapietro VR, Ceccarelli F, Pogliacomi F, Vaienti E, Piccolo C, Capasso R, Sica A, Cioce F, Carbone M, Bruno F, Masciocchi C, Miele V. Radiofrequency ablation of osteoid osteoma. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:175-185. [PMID: 29350646 PMCID: PMC6179079 DOI: 10.23750/abm.v89i1-s.7021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 01/12/2018] [Indexed: 01/24/2023]
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. (www.actabiomedica.it)
Collapse
|
14
|
Anterior Impingement Syndrome of the Ankle Caused by Osteoid Osteoma in the Talar Neck Treated with Arthroscopy and 3D C-Arm-Based Imaging. Case Rep Orthop 2017; 2017:2171627. [PMID: 28458936 PMCID: PMC5387828 DOI: 10.1155/2017/2171627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 03/23/2017] [Indexed: 01/07/2023] Open
Abstract
Osteoid osteoma in periarticular lesions tends to have an unusual presentation that likely leads to a delayed or missed diagnosis compared with a typical osteoid osteoma in the metaphysis or diaphysis of the long bone. In cases that are unresponsive to conservative treatment, surgical interventions including en bloc resection, computed tomography-guided percutaneous treatment, and arthroscopic resection have been performed; however, these methods frequently result in inadequate tumor resection and recurrence. Here we present a case of a 16-year-old girl with osteoid osteoma in the talar neck presenting as anterior impingement syndrome due to marked synovitis in the ankle joint which was successfully treated without complications by arthroscopic synovectomy and tumor resection followed by intraoperative 3D C-arm-based imaging confirming complete tumor lesion removal. Her pain was relieved immediately after the surgery, and there was no recurrence at 12 months of follow-up. This is the first case report of the surgical treatment of the osteoid osteoma in the talar neck with the combination methods of arthroscopy and 3D C-arm-based imaging.
Collapse
|
15
|
He H, Xu H, Lu H, Dang Y, Huang W, Zhang Q. A misdiagnosed case of osteoid osteoma of the talus: a case report and literature review. BMC Musculoskelet Disord 2017; 18:35. [PMID: 28114974 PMCID: PMC5259835 DOI: 10.1186/s12891-017-1413-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 01/17/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Osteoid osteoma (OO) is a common benign bone tumour that is rarely found in the talus. Its nidus is difficult to detect on early imaging. The atypical symptoms of OO and the presence of concurrent trauma or sports injuries may lead to misdiagnosis and delayed treatment. We herein analyse a case of misdiagnosis of OO of the talus and discuss how to improve the early diagnosis of this rare lesion, thereby permitting rapid treatment. CASE PRESENTATION A 23-year-old man with a history of left ankle sprains and chronic pain was diagnosed with another ankle sprain and managed conservatively based on normal X-ray findings. After 1 year of recurring pain, he was diagnosed with ankle traumatic arthritis and underwent arthroscopic surgery. His preoperative ankle X-ray findings were still normal, and magnetic resonance imaging at that time demonstrated bone marrow oedema of the left talus. His symptoms reappeared shortly after surgery and progressively worsened. Magnetic resonance imaging performed 3 months after surgery demonstrated widespread bone marrow oedema of the talus. The patient presented to our hospital for pain assessment and was diagnosed with OO of the talus 3 years after his symptoms began. Preoperative computed tomography (CT) demonstrated a typical nidus of OO of the talus. After a second surgery, the patient's symptoms completely resolved, and pathologic examination confirmed that the lesion was OO. The patient recovered 3 months later and was able to walk normally. CONCLUSIONS OO of the ankle joint exhibits a progressive course and is difficult to diagnose at an early stage. Patients with OO of the talus often have atypical imaging findings, no signs of ankle instability, and no anterior talofibular ligament tenderness. CT is valuable for diagnosing OO, although multiple CT scans may be required to detect the nidus. Proper imaging helps doctors to achieve the correct diagnosis early in the disease course, significantly shortening the treatment cycle and improving the patient's quality of life.
Collapse
Affiliation(s)
- Huan He
- Department of Orthopaedics, Jiangyou 903 Hospital, Mianyang No. 9 Huafengxincun, Jiangyou, Sichuan, 621700, China
| | - Hailin Xu
- Department of Trauma and Orthopaedics, People's Hospital, Peking University, South Xizhimen Street No. 11, Beijing, Xicheng District, 100044, China.
| | - Hao Lu
- Department of Trauma and Orthopaedics, People's Hospital, Peking University, South Xizhimen Street No. 11, Beijing, Xicheng District, 100044, China
| | - Yu Dang
- Department of Trauma and Orthopaedics, People's Hospital, Peking University, South Xizhimen Street No. 11, Beijing, Xicheng District, 100044, China
| | - Wei Huang
- Department of Trauma and Orthopaedics, People's Hospital, Peking University, South Xizhimen Street No. 11, Beijing, Xicheng District, 100044, China
| | - Qing Zhang
- Medical Affairs Department of Hubei Province Traditional Chinese Medicine, Luoyu Road No. 856, Wuhan, 430074, China
| |
Collapse
|
16
|
Arıkan Y, Yavuz U, Lapcin O, Sökücü S, Özkan B, Kabukçuoğlu Y. Percutaneous radiofrequency ablation for osteoid osteoma under guidance of threedimensional fluoroscopy. J Orthop Surg (Hong Kong) 2016; 24:398-402. [PMID: 28031515 DOI: 10.1177/1602400326] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To evaluate the outcome of percutaneous radiofrequency ablation under guidance of 3-dimensional fluoroscopy in 17 patients with osteoid osteoma. METHODS Records of 11 male and 6 female consecutive patients aged 4 to 28 (mean, 13.8) years who underwent radiofrequency ablation under guidance of 3-dimensional fluoroscopy for osteoid osteoma and were followed up for a mean of 15.8 (range, 12-28) months were reviewed. All patients had been treated with analgesics but failed to achieve lasting pain relief. Visual analogue score (VAS) for pain was assessed pre- and post-operatively. Absence of pain was considered recovery. RESULTS The mean operating time was 55 (range, 20-95) minutes, and the mean length of hospital stay was 2.8 (range, 2-7) days. The mean amount of radiation was 390.2 (range, 330.5-423.6) mGy/cm. Relief of pain occurred within the first 24 hours in 11 patients and by the end of the first week in 3 patients. Pain persisted in 3 patients at one month; they underwent revision surgery and achieved complete recovery. The mean VAS for pain was 7.2 (range, 6-9) in 17 patients preoperatively and decreased to 0.64 (range, 0-2) in the 14 patients with pain relief and 0.66 (range, 0-1) in the 3 patients after revision surgery. Two patients had severe discharge from the wound secondary to fat necrosis, which resolved within a week with antibiotics and local dressings. No patient had cellulitis, vasomotor instability, neurovascular injury, fracture, or deep infection. CONCLUSION Percutaneous radiofrequency ablation under guidance of 3-dimensional fluoroscopy is a viable treatment option for osteoid osteoma.
Collapse
Affiliation(s)
- Yavuz Arıkan
- Orthopaedics and Traumatology Department, MS Baltalimani Bone Diseases Training and Research Hospital, Turkey
| | | | | | | | | | | |
Collapse
|
17
|
Wolf M. Knee Pain in Children, Part III: Stress Injuries, Benign Bone Tumors, Growing Pains. Pediatr Rev 2016; 37:114-8; quiz 119. [PMID: 26933226 DOI: 10.1542/pir.2015-0042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Michael Wolf
- Pediatrics and Orthopedic Surgery, St Christopher's Hospital for Children, Philadelphia, PA
| |
Collapse
|
18
|
Singh JP, Srivastava S, Singh D. Osteoid osteoma masquerading tubercular arthritis or osteomyelitis on MRI: Case series and review of literature. Indian J Radiol Imaging 2015; 25:261-8. [PMID: 26288520 PMCID: PMC4531450 DOI: 10.4103/0971-3026.161447] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Magnetic resonance imaging (MRI) scans for osteoid osteoma could be misleading and can be misinterpreted as tuberculosis, especially when used as the principal modality of investigation. We retrospectively reviewed cases presenting to our institute for second opinion and selected six cases that were referred to our institute with a provisional diagnosis of tubercular arthritis or osteomyelitis and were identified to have osteoid osteoma. We reviewed the literature on typical and atypical clinical and radiological presentations of osteoid osteoma depending upon their location and present radiological features on MRI that should alert the radiologists toward a correct diagnosis.
Collapse
Affiliation(s)
| | - Smita Srivastava
- Department of Radiology, Medanta-The Medicity, Gurgaon, Haryana, India
| | - Dharmendra Singh
- Department of Orthopaedic Surgery, Medanta-The Medicity, Gurgaon, Haryana, India
| |
Collapse
|
19
|
Natali GL, Paolantonio G, Fruhwirth R, Alvaro G, Parapatt GK, Toma' P, Rollo M. Paediatric musculoskeletal interventional radiology. Br J Radiol 2015; 89:20150369. [PMID: 26235144 DOI: 10.1259/bjr.20150369] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Interventional radiology technique is now well established and widely used in the adult population. Through minimally invasive procedures, it increasingly replaces surgical interventions that involve higher percentages of invasiveness and, consequently, of morbidity and mortality. For these advantageous reasons, interventional radiology in recent years has spread to the paediatric age as well. The aim of this study was to review the literature on the development, use and perspectives of these procedures in the paediatric musculoskeletal field. Several topics are covered: osteomuscle neoplastic malignant and benign pathologies treated with invasive diagnostic and/or therapeutic procedures such as radiofrequency ablation in the osteoid osteoma; invasive and non-invasive procedures in vascular malformations; treatment of aneurysmal bone cysts; and role of interventional radiology in paediatric inflammatory and rheumatic inflammations. The positive results that have been generated with interventional radiology procedures in the paediatric field highly encourage both the development of new ad hoc materials, obviously adapted to young patients, as well as the improvement of such techniques, in consideration of the fact that childrens' pathologies do not always correspond to those of adults. In conclusion, as these interventional procedures have proven to be less invasive, with lower morbidity and mortality rates as well, they are becoming a viable and valid alternative to surgery in the paediatric population.
Collapse
Affiliation(s)
- Gian L Natali
- 1 Interventional Radiology Unit, "Bambino Gesù" Children's Hospital, Rome, Italy
| | | | - Rodolfo Fruhwirth
- 1 Interventional Radiology Unit, "Bambino Gesù" Children's Hospital, Rome, Italy
| | - Giuseppe Alvaro
- 1 Interventional Radiology Unit, "Bambino Gesù" Children's Hospital, Rome, Italy
| | - George K Parapatt
- 1 Interventional Radiology Unit, "Bambino Gesù" Children's Hospital, Rome, Italy
| | - Paolo Toma'
- 2 Imaging Department, "Bambino Gesù" Children's Hospital, Rome, Italy
| | - Massimo Rollo
- 1 Interventional Radiology Unit, "Bambino Gesù" Children's Hospital, Rome, Italy
| |
Collapse
|
20
|
Infante J, Lorente R, Rayo J, Serrano J, Domínguez M, García L, Moreno M. The use of radioguided surgery in the resection of osteoid osteoma. Rev Esp Med Nucl Imagen Mol 2015. [DOI: 10.1016/j.remnie.2015.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
21
|
Sampath SC, Sampath SC, Rosenthal DI. Serially recurrent osteoid osteoma. Skeletal Radiol 2015; 44:875-81. [PMID: 25503857 DOI: 10.1007/s00256-014-2061-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 11/04/2014] [Accepted: 11/10/2014] [Indexed: 02/02/2023]
Abstract
Osteoid osteoma is a relatively common, benign, painful tumor of bone. It is widely believed to run a course culminating in spontaneous regression. The tumor can usually be eliminated by excision or ablation, although it may recur locally. Although management has classically been surgical, thermocoagulation via percutaneously delivered radiofrequency energy has demonstrated excellent results, typically resulting in durable response following a single treatment. Here, we present an unusual case of serially recurrent pathologically proven pediatric osteoid osteoma, treated by radiofrequency ablation five times over the course of 11 years. Limitations of RF ablation of osteoid osteoma and possible factors predisposing to incomplete treatment or recurrence are discussed.
Collapse
Affiliation(s)
- Srihari C Sampath
- Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital, Boston, MA, 02113, USA
| | | | | |
Collapse
|
22
|
Infante JR, Lorente R, Rayo JI, Serrano J, Domínguez ML, García L, Moreno M. [Use of radioguided surgery in the surgical treatment of osteoid osteoma]. Rev Esp Med Nucl Imagen Mol 2015; 34:225-9. [PMID: 25743036 DOI: 10.1016/j.remn.2015.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 01/22/2015] [Accepted: 01/24/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Osteoid osteoma is the third most common benign bone tumor and complete surgical resection is definitive treatment. There are a limited number of publications on the use of radioguided surgery in this type of lesion. To assess the utility of radioguided surgery in our environment as a method of surgical treatment of this tumor. MATERIAL AND METHODS We retrospectively evaluated 12 patients (2 women and 10 men, age range 9-44 years) with clinical and radiological suspicion of osteoid osteoma. Bone scintigraphy showed foci of pathology uptake compatible with suspected lesion in the femur (4 cases), tibia (3), vertebral column (3), humerus (1) and talus (1). Subsequently patients underwent surgical treatment by radioguided surgery after injection of a dose of (99m)Tc-hydroxy diphosphonate. The nidus was removed using gamma probe and mini gamma camera, considering the technique to be completed when its counts decreased to the levels of the surrounding bone counts. RESULTS Lesions were located in all patients (12 of 12), and were confirmed histologically in 8 of them, including an osteoblastoma. The cure rate was 100%, based on the disappearance of pain after a minimum follow-up of 6 months. CONCLUSION Use of radioguided surgery in the surgical treatment of osteoid osteoma showed satisfactory results, with 100% efficiency in both lesion location and outcome of treatment and without major postoperative complications.
Collapse
Affiliation(s)
- J R Infante
- Servicio de Medicina Nuclear, Complejo Hospitalario Universitario de Badajoz, Badajoz, España.
| | - R Lorente
- Servicio de Traumatología, Complejo Hospitalario Universitario de Badajoz, Badajoz, España
| | - J I Rayo
- Servicio de Medicina Nuclear, Complejo Hospitalario Universitario de Badajoz, Badajoz, España
| | - J Serrano
- Servicio de Medicina Nuclear, Complejo Hospitalario Universitario de Badajoz, Badajoz, España
| | - M L Domínguez
- Servicio de Medicina Nuclear, Complejo Hospitalario Universitario de Badajoz, Badajoz, España
| | - L García
- Servicio de Medicina Nuclear, Complejo Hospitalario Universitario de Badajoz, Badajoz, España
| | - M Moreno
- Servicio de Medicina Nuclear, Complejo Hospitalario Universitario de Badajoz, Badajoz, España
| |
Collapse
|
23
|
99mTc-Methylene diphosphonate SPECT/CT as the one-stop imaging modality for the diagnosis of osteoid osteoma. Nucl Med Commun 2015; 35:876-83. [PMID: 24751704 DOI: 10.1097/mnm.0000000000000134] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to evaluate the utility of Tc-methylene diphosphonate (Tc-MDP) single-photon emission tomography (SPECT)/computed tomography (CT) for the diagnosis of osteoid osteoma and compare the same with three-phase planar bone scintigraphy (BS) and CT alone. MATERIALS AND METHODS Data of 31 patients (age: 20.6±13.2 years; male: 80.6%) who had undergone Tc-MDP BS with SPECT/CT for clinically and/or radiographically suspected osteoid osteoma were retrospectively evaluated. Planar BS images were analyzed by an experienced nuclear medicine physician. CT images were evaluated by an experienced radiologist. SPECT/CT images were evaluated by the nuclear medicine physician and radiologist in consensus. On the basis of the diagnostic confidence the interpreters used a scoring scale of 1-3, in which 1 is negative for osteoid osteoma, 2 is equivocal, and 3 is positive for osteoid osteoma. For the calculation of sensitivity, specificity, and predictive values for planar BS, CT, and SPECT/CT an interpretive score of 2 or higher was taken as positive for osteoid osteoma. Receiver operating characteristic curve analysis was performed and the area under the curve was calculated and compared. Histopathology and microbiology/clinical imaging follow-up was used as the reference standard. RESULTS There were nine equivocal lesions on planar BS and five equivocal lesions on CT, but none on SPECT/CT. The sensitivity, specificity, and accuracy of SPECT/CT were all 100%; those of CT were 77.8, 92.3, and 83.8% and those of planar BS were 100, 38.4, and 74.1%, respectively. On comparison, the area under the curve of SPECT/CT was significantly larger than that of planar BS (1.00 vs. 0.761; P=0.005) and CT (1.00 vs. 0.872; P=0.044). However, no significant difference was seen between planar BS and CT (0.761 vs. 0.872; P=0.236). CONCLUSION Tc-MDP SPECT/CT shows excellent diagnostic accuracy for osteoid osteoma and can be used as a one-stop imaging modality for the same. It is superior to planar BS and CT alone for the diagnosis of suspected osteoid osteoma.
Collapse
|
24
|
Abstract
Purpose. Our aim is to evaluate the results of treatment with computed tomography (CT) guided percutaneous radiofrequency ablation for osteoid osteomas which were localized in a difficult area for operation. Materials and Methods. Glenoid, distal tibia, humerus shaft, proximal humerus, and in third finger of the hand proximal phalanx were involved in one patient. Proximal femur was involved in three patients, distal femur was involved in three patients, and proximal tibia was involved in two patients. 9 males and 4 females were aged 4 to 34 years (mean age: 18.5 years). All patients had pain and were evaluated with X-rays, CT, bone scintigraphy, and MRI. In all patients, RF ablation was performed with local anesthesia. The lesion heated to 90°C for 6 minutes. Results. All of the patients achieved complete pain relief after ablation and were fully weight bearing without any support. In all patients, there was soft tissue edema after the procedure. During follow-up, all patients were free from the pain and there was no sign about the tumor. There was no other complication after the process. Conclusion. CT guided RFA is a minimally invasive, safe, and cost-effective treatment for osteoid osteoma placed in difficult area for surgery.
Collapse
|
25
|
Chakraverty J, Al-Mokhtar N, James SL. Osteoid osteoma of the cuboid managed by percutaneous radiofrequency ablation. J Foot Ankle Surg 2014; 53:212-5. [PMID: 24556489 DOI: 10.1053/j.jfas.2013.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Indexed: 02/03/2023]
Abstract
We present details of a case of osteoid osteoma of the tarsal cuboid bone. Osteoid osteoma arising in the foot is not very common, and localization in the cuboid is rare. To our knowledge, this is the first case of osteoid osteoma of the cuboid bone treated successfully by percutaneous radiofrequency ablation.
Collapse
Affiliation(s)
- Julian Chakraverty
- Department of Radiology, Princess of Wales Hospital, Bridgend, Cardiff, UK.
| | - Namir Al-Mokhtar
- Department of Radiology, Princess of Wales Hospital, Bridgend, Cardiff, UK
| | - Steven L James
- Department of Radiology, Royal Orthopaedic National Health Service Foundation Trust, Northfield, Birmingham, UK
| |
Collapse
|
26
|
Ciftdemir M, Tuncel SA, Usta U. Atypical osteoid osteomas. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2013; 25:17-27. [PMID: 23975583 DOI: 10.1007/s00590-013-1291-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Accepted: 07/31/2013] [Indexed: 12/30/2022]
Abstract
Osteoid osteoma is a very painful benign bone tumor that affects young adults. It is exceptional before 5 and after 30 years of age. It can be seen in any part of the skeleton. Presentation of the tumor may be intracortical, juxta-cortical or cancellous. In long bones, the tumor is frequently intracortical, and in the spine, it is usually located at the posterior elements. Osteoid osteomas having radiologic and clinical features other than classical presentation of osteoid osteoma are called atypical osteoid osteomas. Atypical osteoid osteomas are important because the diagnosis and treatment are often complicated in these cases. Misdiagnosis with prolonged impairment and sometimes overtreatment appears as a major problem concerning atypical osteoid osteomas. This paper gives brief general information about the classical presentation of osteoid osteoma, discusses the pathogenesis of the lesion and focuses on the clinical presentation, radiologic features and characteristics of atypical osteoid osteomas as well as their treatment modalities.
Collapse
Affiliation(s)
- Mert Ciftdemir
- Department of Orthopaedic Surgery, Trakya University School of Medicine, Balkan Yerleskesi, 22030, Edirne, Turkey,
| | | | | |
Collapse
|
27
|
de Palma L, Candelari R, Antico E, Politano R, Luniew E, Giordanengo M, Di Giansante S, Marinelli M, Paci E. Treatment of osteoid osteoma with CT-guided percutaneous radiofrequency thermoablation. Orthopedics 2013; 36:e581-7. [PMID: 23672909 DOI: 10.3928/01477447-20130426-19] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Osteoid osteoma is a benign bone tumor with a male predominance occurring mainly in children and young adults. The most common symptom is intermittent pain that worsens at night and is at least partially relieved by nonsteroidal anti-inflammatory drugs. The purpose of this study was to assess the long-term effectiveness of computed tomography-guided percutaneous radiofrequency thermoablation in patients with a minimum follow-up of 2 years. Twenty patients with osteoid osteoma (15 men and 5 women) with a mean age of 20.7 years (range, 4-61 years; 12 patients aged 20 years or younger) underwent computed tomography-guided percutaneous radiofrequency thermoablation. Lesion sites were the femur (n=9), tibia (n=7), pelvis (n=1), talus (n=1), cuneiform bone (n=1), and humerus (n=1). Mean follow-up was 44 months (range, 3-106 months). Pain relief was significant in 95% of patients; it disappeared within 24 hours in 14 patients, within 3 days in 4, and within 7 days in 1. The patient with persistent symptoms underwent another percutaneous radiofrequency thermoablation procedure that was successful. The difference between pre- and postoperative pain was significant (P ≤ .01). No recurrences occurred. Computed tomography-guided percutaneous radiofrequency thermoablation is a safe, minimally invasive, and economical procedure with high technical and clinical success rates, and it effectively and durably enhances quality of life.
Collapse
Affiliation(s)
- Luigi de Palma
- Clinic Orthopaedic, Marche Polytechnic University, Ancona Hospital, Via Conca 71, 60100 Ancona, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
28
|
|
29
|
Bhusnurmath S, Hoch B. Benign Bone-Forming Tumors: Approach to Diagnosis and Current Understanding of Pathogenesis. Surg Pathol Clin 2011; 5:101-16. [PMID: 26837917 DOI: 10.1016/j.path.2011.07.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The diagnosis of benign bone-forming tumors continues to be based on the traditional approach to bone tumor diagnosis using knowledge of the spectrum of histopathologic features seen in these tumors in combination with clinical and radiological correlation. This review emphasizes the pathologic features and the clinical and radiological features that the surgical pathologist must have a working understanding of to make an accurate diagnosis and avoid confusion with other lesions, particularly osteosarcoma. New and persistent challenges facing the practicing pathologist and our current understanding of the cytogenetic and molecular abnormalities involved in the pathogenesis of these tumors are discussed.
Collapse
Affiliation(s)
- Shefali Bhusnurmath
- Department of Pathology, University of Washington, 1959 NE Pacific Street, Box 356100, Room NE110, Seattle, WA 98195, USA
| | | |
Collapse
|
30
|
Aratake M, Shigeyuki M, Atsushi H, Takeuchi R, Saito T. Case of juxta-articular osteoid osteoma of calcaneus mimicking arthritis. J Foot Ankle Surg 2011; 51:237-40. [PMID: 22154062 DOI: 10.1053/j.jfas.2011.10.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Indexed: 02/03/2023]
Abstract
Juxta-articular osteoid osteoma is a rare disorder that is difficult to correctly diagnose at an early stage. We report a case of osteoid osteoma in the calcaneus that arose near to the talocalcaneal joint. An 18-year-old female presented with symptoms of joint swelling and effusion similar to those of monoarthritis. Conservative treatment proved ineffective in achieving pain relief, and she underwent surgery 6 months later. The lesion was diagnosed by histologic examination, and it resolved after resection of the tumor.
Collapse
Affiliation(s)
- Masato Aratake
- Department of Orthopaedic Surgery, Fujisawa City Hospital, Fujisawa City, Japan.
| | | | | | | | | |
Collapse
|
31
|
Zoubir E, Frikha F, Trigui M, Bouaziz W, Ayedi L, Aoui M, Gdoura F, Dabbeh C, Bahloul Z, Boudawara T, Ayedi K, Keskes H. [Intra-articular osteoid osteoma of the hip: two cases and review of the literature]. Pan Afr Med J 2011; 8:5. [PMID: 22121414 PMCID: PMC3221407 DOI: 10.4314/pamj.v8i1.71051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Accepted: 01/30/2011] [Indexed: 11/17/2022] Open
Abstract
Abstract L’ostéome ostéoïde est une tumeur osseuse bénigne qui affecte les adultes jeunes et se localise préférentiellement au niveau des os longs. La localisation intra-articulaire est rare et atteint le plus souvent la hanche. La symptomatologie clinique est alors atypique et peut faire errer le diagnostic constituant un défi diagnostique pour les cliniciens. Nous rapportons deux observations d’ostéome ostéoïde intra-articulaires de la hanche chez deux hommes âgés 24 et 45 ans, révélés par des douleurs de la hanche gauche de type inflammatoire évoluant depuis un an et un an et demi respectivement. Chez les deux patients, le tableau atypique de l’ostéome ostéoïde a été à l’origine d’un retard diagnostic. La tomodensitométrie est dans cette indication l’examen le plus spécifique qui a permis d’évoquer le diagnostic d’ostéome ostéoïde. Une fois le diagnostic est posé, l’exérèse chirurgicale à ciel ouvert a permis la guérison avec disparition totale des douleurs. L’examen histologique a confirmé le diagnostic final d’ostéome ostéoïde intra-articulaire dans les deux cas.
Collapse
Affiliation(s)
- Ellouz Zoubir
- Service d'Orthopédie et Traumatologie CHU Habib Bourguiba 3029 Sfax, Tunisia
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Davies CE, James SLJ. Retrieval of a fractured drill tip during osteoid osteoma treatment. Clin Radiol 2010; 65:1018-20. [PMID: 21070907 DOI: 10.1016/j.crad.2010.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Revised: 04/12/2010] [Accepted: 04/21/2010] [Indexed: 10/19/2022]
Affiliation(s)
- C E Davies
- Department of Radiology, The Royal Orthopaedic Hospital NHS Foundation Trust, Northfield, Birmingham, UK
| | | |
Collapse
|
33
|
Chai JW, Hong SH, Choi JY, Koh YH, Lee JW, Choi JA, Kang HS. Radiologic diagnosis of osteoid osteoma: from simple to challenging findings. Radiographics 2010; 30:737-49. [PMID: 20462991 DOI: 10.1148/rg.303095120] [Citation(s) in RCA: 136] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Osteoid osteoma is characterized by an intracortical nidus with a variable amount of calcification, as well as cortical thickening, sclerosis, and bone marrow edema. When these findings are present, a diagnosis of osteoid osteoma is easily made. However, osteoid osteoma may display imaging findings that can be misleading, and it can be difficult to differentiate osteoid osteoma from other conditions such as infection, inflammatory and noninflammatory arthritis, and other tumors. In addition, stress fracture, intracortical abscess, intracortical hemangioma, chondroblastoma, osteoblastoma, and compensatory hypertrophy of the pedicle may mimic osteoid osteoma. To make the correct diagnosis, it is necessary to identify the nidus, and it is important to be familiar with the radiologic findings of osteoid osteoma and its mimics.
Collapse
Affiliation(s)
- Jee Won Chai
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, 101 Daehang-ro, Chongno-gu, Seoul 110-744, Korea; Boramae Medical Center, Seoul, Korea
| | | | | | | | | | | | | |
Collapse
|
34
|
|
35
|
Motamedi D, Learch TJ, Ishimitsu DN, Motamedi K, Katz MD, Brien EW, Menendez L. Thermal ablation of osteoid osteoma: overview and step-by-step guide. Radiographics 2010; 29:2127-41. [PMID: 19926767 DOI: 10.1148/rg.297095081] [Citation(s) in RCA: 121] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Osteoid osteoma is a small, benign but painful lesion with specific clinical and imaging characteristics. Computed tomography is the imaging modality of choice for visualization of the nidus and for treatment planning. Complete surgical excision of the nidus is curative, providing symptomatic relief, and is the traditionally preferred treatment. However, surgery has disadvantages, including the difficulty of locating the lesion intraoperatively, the need for prolonged hospitalization, and the possibility of postoperative complications ranging from an unsatisfactory cosmetic result to a fracture. Percutaneous radiofrequency (RF) ablation, which involves the use of thermal coagulation to induce necrosis in the lesion, is a minimally invasive alternative to surgical treatment of osteoid osteoma. With reported success rates approaching 90%, RF ablation should be considered among the primary options available for treating this condition.
Collapse
Affiliation(s)
- Daria Motamedi
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | | | | | | | | | | | | |
Collapse
|
36
|
Chai JW, Hong SH, Choi JY, Koh YH, Lee JW, Choi JA, Kang HS. Radiologic Diagnosis of Osteoid Osteoma: From Simple to Challenging Findings. Radiographics 2010. [DOI: 10.1148/rg.303095120 10.1148/rg.303095120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
37
|
Recurrent intra-articular osteoid osteoma of the hip after radiofrequency ablation: a case report and review of the literature. CASES JOURNAL 2009; 2:6439. [PMID: 19829804 PMCID: PMC2740174 DOI: 10.4076/1757-1626-2-6439] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2009] [Accepted: 06/29/2009] [Indexed: 11/20/2022]
Abstract
We present a case of a 53-year-old woman with recurrent intra-articular osteoid osteoma of the hip 6 months after initial treatment with percutaneous radiofrequency ablation. En bloc surgical excision of the osteoid osteoma and prophylactic internal fixation for impending stress fracture was performed. The patient is pain free, has returned to normal function and there is no sign of recurrence at the one-year follow-up. Intraarticular osteoid osteoma, present a diagnostic challenge and often they are misdiagnosed. Minimally invasive ablation techniques can fail in significant percentage and then surgical excision with histological confirmation remains the definitive treatment of choice.
Collapse
|