Download PDF
CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2017; 27(02): 207-215
DOI: 10.4103/ijri.IJRI_260_16
Intervention Radiology & Vascular

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

Anurag Chahal
Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
,
Prathiba Rajalakshmi
Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
,
Shah A Khan
Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
,
Shishir Rastogi
Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
,
Deep N Srivastava
Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
,
Shivanand Gamanagatti
Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
› Author Affiliations Financial support and sponsorship Nil.
› Further Information
  PDF Download Permissions and Reprints

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.

Keywords

Interventional radiology - osteoid osteoma - therapy


Publication History

Article published online:
27 July 2021

© 2017. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

 

  • References

  • 1 O'Connell JX, Nanthakumar SS, Nielsen GP, Rosenberg AE. Osteoid osteoma: The uniquely innervated bone tumor. Mod Pathol 1998;11:175-80.
  • 2 Sans N, Galy-Fourcade D, Assoun J, Jarlaud T, Chiavassa H, Bonnevialle P, et al. Osteoid osteoma: CT-guided percutaneous resection and follow-up in 38 patients. Radiology 1999;212:687-92.
  • 3 Motamedi D, Learch TJ, Ishimitsu DN, Motamedi K, Katz MD, Brien EW, et al. Thermal Ablation of Osteoid Osteoma: Overview and Step-by-Step Guide1. RadioGraphics 2009;29:2127-41.
  • 4 Assoun J, Richardi G, Railhac JJ, Baunin C, Fajadet P, Giron J, et al. Osteoid osteoma: MR imaging versus CT. Radiology 1994;191:217-23.
  • 5 Helms CA. Osteoid osteoma. The double density sign. Clin Orthop 1987;222:167-73.
  • 6 Rosenthal DI, Alexander A, Rosenberg AE, Springfield D. Ablation of osteoid osteomas with a percutaneously placed electrode: A new procedure. Radiology 1992;183:29-33.
  • 7 Gangi A, Dietemann JL, Gasser B, Mortazavi R, Brunner P, Mourou MY, et al. Interstitial laser photocoagulation of osteoid osteomas with use of CT guidance. Radiology 1997;203:843-8.
  • 8 Adam G, Keulers P, Vorwerk D, Heller KD, Füzesi L, Günther RW. The percutaneous CT-guided treatment of osteoid osteomas: Acombined procedure with a biopsy drill and subsequent ethanol injection. RöFo 1995;162:232-5.
  • 9 Skjeldal S, Lilleås F, Follerås G, Stenwig AE, Samset E, Tillung T, et al. Real time MRI-guided excision and cryo-treatment of osteoid osteoma in os ischii-a case report. Acta Orthop Scand 2000;71:637-8.
  • 10 Woertler K, Vestring T, Boettner F, Winkelmann W, Heindel W, Lindner N. Osteoid osteoma: CT-guided percutaneous radiofrequency ablation and follow-up in 47 patients. J Vasc Interv Radiol 2001;12:717-22.
  • 11 Vanderschueren GM, Taminiau AHM, Obermann WR, Bloem JL. Osteoid osteoma: Clinical results with thermocoagulation. Radiology 2002;224:82-6.
  • 12 Rosenthal DI, Hornicek FJ, Torriani M, Gebhardt MC, Mankin HJ. Osteoid osteoma: Percutaneous treatment with radiofrequency energy. Radiology 2003;229:171-5.
  • 13 Rosenthal DI, Hornicek FJ, Wolfe MW, Jennings LC, Gebhardt MC, Mankin HJ. Decreasing length of hospital stay in treatment of osteoid osteoma. Clin Orthop 1999;361:186-91.
  • 14 Lindner NJ, Ozaki T, Roedl R, Gosheger G, Winkelmann W, Wörtler K. Percutaneous radiofrequency ablation in osteoid osteoma. J Bone Joint Surg Br 2001;83:391-6.
  • 15 Mahnken AH, Tacke JA, Wildberger JE, Günther RW. Radiofrequency ablation of osteoid osteoma: Initial results with a bipolar ablation device. J Vasc Interv Radiol 2006;17:1465-70.
  • 16 Goldberg SN, Charboneau JW, Dodd GD, Dupuy DE, Gervais DA, Gillams AR, et al. Image-guided tumor ablation: Proposal for standardization of terms and reporting criteria. Radiology 2003;228:335-45.
  • 17 Pinto CH, Taminiau AH, Vanderschueren GM, Hogendoorn PC, Bloem JL, Obermann WR. Technical considerations in CT-guided radiofrequency thermal ablation of osteoid osteoma: Tricks of the trade. Am J Roentgenol 2002;179:1633-42.
  • 18 Organ LW. Electrophysiologic principles of radiofrequency lesion making. Appl Neurophysiol 1976 1977;39:69-76.
  • 19 Vanderschueren GM, Taminiau AHM, Obermann WR, van den Berg-Huysmans AA, Bloem JL, van Erkel AR. The healing pattern of osteoid osteomas on computed tomography and magnetic resonance imaging after thermocoagulation. Skeletal Radiol 2007;36:813-21.
  • 20 Chai JW, Hong SH, Choi J-Y, Koh YH, Lee JW, Choi J-A, et al. Radiologic diagnosis of osteoid osteoma: From simple to challenging findings. Radiographics 2010;30:737-49.
  • 21 Hoffmann RT, Jakobs TF, Kubisch CH, Trumm CG, Weber C, Duerr HR, et al. Radiofrequency ablation in the treatment of osteoid osteoma—5-year experience. Eur J Radiol 2010;73:374-9.
  • 22 Vanderschueren GM, Taminiau AHM, Obermann WR, van den Berg-Huysmans AA, Bloem JL. Osteoid osteoma: Factors for increased risk of unsuccessful thermal coagulation. Radiology 2004;233:757-62.