Treatment of aneurysmal bone cysts by percutaneous CT-guided injection of calcitonin and steroid.

Abstract

To determine the efficacy and safety of percutaneous calcitonin and steroid injection in the treatment of aneurysmal bone cysts (ABCs). Our study was IRB-approved and HIPAA-compliant. We reviewed pre- and post-procedural imaging studies and medical records of all CT-guided percutaneous injections of ABCs with calcitonin and steroid performed at our institution between 2003 and 2015. Treatment success based on imaging was categorized as substantial (51-100%), partial (1-50%), or none (0%) by comparing radiographs of the lesion before and after treatment. Our study group comprised 9 patients (7female, 2male; mean age 19 ± 5 (range 12-25) years). ABCs were located in the pubis (n = 3), femur (n = 2), and humerus/scapula/ilium/sacrum (n = 1 for each). One patient did not have any clinical or imaging follow-up. For the other 8 patients, clinical and imaging follow-up ranged from 1 to 93months (mean 16 ± 29months). One patient had two injections, and 1 patient had three injections. Six out of eight patients (75%) had complete symptomatic relief and 2 patients (25%) had partial symptomatic relief after initial injection. Imaging follow-up revealed substantial imaging response in 4 out of 8 patients (50%). There was a partial imaging response in 2 patients (25%) and no imaging response in 2 out of 8 patients (25%), and all 4 of these patients had local recurrence. There were no complications. Percutaneous CT-guided injection of ABCs with calcitonin and steroid is a safe and effective treatment. Lack of imaging response may necessitate more aggressive treatment to minimize local recurrence.