Cone beam computed tomography (CBCT) guidance is helpful in reducing dose exposure to pediatric patients undergoing radiofrequency ablation of osteoid osteoma

Francesco Fiore,Roberto D’Angelo,Luca Tarotto,Vincenzo Stoia,Francesco Somma

doi:10.1007/s11547-021-01439-4

Abstract

PurposeTo assess efficacy and safety of cone beam computed tomography (CBCT) in the radiofrequency ablation (RFA) of osteoid osteoma (OO) in children and adolescents, and to compare technical success, clinical success, radiation dose and procedure duration time of CBCT guidance to conventional computed tomography (CT) guidance.Materials and methodsBetween 2015 and 2019, 53 consecutive percutaneous RFA were performed on pediatric patients with CBCT or conventional CT guidance, respectively, in 24 and 29 children and adolescents with 24-month follow-up. Dose area product (DAP) and dose length product (DLP) were recorded, respectively, for CBCT and conventional CT and converted to effective doses (ED).ResultsCBCT and conventional CT groups were similar in terms of patient age and weight, tumor size and tumor location. Technical success was achieved in all cases. Primary clinical success was 91.67% (22/24) for the CBCT group and 89.66% (26/29) for the conventional CT group. Mean DAP was 64.75Gycm2 (range 6.0–266.7). Mean DLP was 972.62mGycm (range 337–2344). ED was significantly lower in the CBCT group compared to the conventional CT group (0.34 mSv vs. 5.53 mSv, p = 0.0119). Procedure duration time was not significantly longer in the CBCT group (102.25 min vs. 92.34 min, p = 0.065). No major complication was registered. Minor complications were observed in 4 patients (2 in CBCT; 2 in conventional CT).ConclusionsCompared to conventional CT guidance, CBCT guidance for percutaneous OO ablation shows similar technical and clinical success rates, with reduced radiation dose and equivalent procedure duration time. This technique helps sparing dose exposure to pediatric patients.

Highlights

Osteoid osteoma (OO) is a benign bone tumor that commonly arises in children and adolescents and is slightly predominant in male population [1]
Between March 2014 and March 2019, 55 consecutive pediatric patients were evaluated in our Interventional Radiology Department for chronic bone pain with nocturnal exacerbation relieved by salicylates and eventually diagnosed with OO based on radiographic, Computed Tomography (CT) and/or magnetic resonance imaging (MRI) findings and clinical history
An unenhanced cone beam computed tomography (CBCT) of the anatomic region was performed, and images were reviewed on an adjacent workstation in order to identify target site and skin entrance area on multiplanar reconstructions (MPR)

Summary

Introduction

Osteoid osteoma (OO) is a benign bone tumor that commonly arises in children and adolescents and is slightly predominant in male population [1]. It is seen as a little central nidus surrounded by peripheral reactive zone of osteoblasts and thickened cortical bone and fibrotic tissue with vascular elements [2]. Imaging-guided percutaneous thermal ablation techniques, such as radiofrequency ablation (RFA), cryoablation, microwave ablation (MWA), laser photocoagulation and Magnetic Resonance-guided Focused Ultrasound (MRgFUS), became. CT-guided RFA is the most common technique among percutaneous treatment of OO at present. Limiting exposure of patients to ionizing radiation is necessary in all patients and mandatory in children and adolescents, forcing radiologists to lower radiation exposure in case of OO ablation

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Conclusion