Abstract
Previous studies suggest that interventional ablative procedures on bone lesions may weaken the bone, especially when performed through the needle approach. Our purpose was to evaluate, through Computed Tomography (CT), the effects of Magnetic Resonance guided Focused Ultrasound Surgery (MRgFUS) ablation on painful osteoid osteomas and osteoblastomas in terms of bone density and morphological changes. We retrospectively evaluated patients treated at our institution with MRgFUS for superficial, painful osteoid osteoma or osteoblastoma during the last 9 years. Inclusion criteria were procedural and clinical success, as well as the availability of pre- and postprocedural CT examinations. Imaging features assessed were perilesional/nidus density changes and the occurrence of pathological fractures during the follow-up period. Our study population included 31 osteoid osteomas and 5 intra-articular osteoblastomas in 36 treated patients. We found an increased bone density of the lesions when pre and post-treatment CT- values were compared: these differences were statistically significant, and this finding is consistent with significant bone densification at the post-treatment imaging follow-up. No pathological fractures were observed after ablation during the follow-up. MRgFUS can be considered to be the treatment of choice for benign superficial bone lesions, thanks to its minimal invasiveness, excellent effectiveness, and safety. Pathological fractures, reported in literature as a rare event using needle ablation, never occurred in our MRgFUS treatment series.
Highlights
One of its shortcomings is that it is suitable only for superficial lesions, due to its physical mechanisms [6–8]. To contribute to this debate, in this study we evaluated the bone density changes within the area of treatment of painful osteoid osteomas and osteoblastomas
We retrospectively evaluated patients treated with Magnetic Resonance guided Focused Ultrasound Surgery (MRgFUS) for superficial painful osteoid osteoma or osteoblastoma at our musculoskeletal interventional center between
Our final study population consisted of 36 patients affected by osteoid osteomas in 31 cases and intra-articular osteoblastomas in five cases (22 males, 14 females, mean age at the time of treatment 23.67 ± 10.44 years)
Summary
Osteoid osteoma (OO) and Osteoblastoma (OB) are benign bone-forming tumors, representing the most common focal and painful benign bone lesions. Their clinical relevance consists in their disabling symptomatology, which is typically responsive to non-steroidal anti-inflammatory drugs (NSAIDS), and functional impairment with a significant social effect, considering their high incidence among young people, without neglecting the possibility of malignant transformation described in the literature, representing 12–25% of OB [1]. The therapeutic management of OO and OB is challenging, as the rare possibility of self-healing OO has been described [2]. Conservative treatments do not represent a reasonable solution, due to the long-term drug therapy that is required
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