Adjuvant MRI-guided percutaneous cryoablation treatment for aneurysmal bone cyst

  • Jan FritzEmail author
  • Lena Sonnow
  • Carol D. Morris
Case Report


Aneurysmal bone cysts are benign, expansile, lytic bone lesions that behave in a locally aggressive manner. Although radiography and computed tomography (CT) can detect the lesion, magnetic resonance imaging (MRI) is ideal for the demonstration of characteristic fluid–fluid levels, extent, and margins. Treatment typically consists of open surgical curettage with the addition of local adjuvants and bone grafting. Residual or recurring lesions may be treated using percutaneous cryoablation. Although CT guidance is often employed for image guidance, visualization and targeting of smaller clusters can be challenging in young children, secondary to the partially mineralized bone matrix in the immature skeleton. In such cases, the higher contrast resolution of interventional MRI affords direct visualization and targeting of small aneurysmal bone cysts, accurate monitoring of the extent of the growing ice ball beyond the lesion’s margin, and avoidance of exposure to ionizing radiation. We report a case of a 5-year-old boy with recurrent or remaining aneurysmal bone cysts of the scapula after surgical excision and embolization, which were successfully treated using MRI-guided cryoablation.


Aneurysmal bone cyst Treatment Recurrence Cryotherapy MRI guidance 


Compliance with ethical standards

Grant support


Conflicts of interest



  1. 1.
    Leithner A, Windhager R, Lang S, Haas OA, Kainberger F, Kotz R. Aneurysmal bone cyst. A population based epidemiologic study and literature review. Clin Orthop Relat Res. 1999;363:176–9.CrossRefGoogle Scholar
  2. 2.
    Cottalorda J, Kohler R, Sales de Gauzy J, et al. Epidemiology of aneurysmal bone cyst in children: a multicenter study and literature review. J Pediatr Orthop B. 2004;13(6):389–94.CrossRefGoogle Scholar
  3. 3.
    Park HY, Yang SK, Sheppard WL, et al. Current management of aneurysmal bone cysts. Curr Rev Musculoskelet Med. 2016;9(4):435–44.CrossRefPubMedCentralGoogle Scholar
  4. 4.
    Bittman RW, Peters GL, Newsome JM, et al. Percutaneous image-guided cryoneurolysis. AJR Am J Roentgenol. 2018;210(2):454–65.CrossRefPubMedCentralGoogle Scholar
  5. 5.
    Chang CY, Kattapuram SV, Huang AJ, Simeone FJ, Torriani M, Bredella MA. Treatment of aneurysmal bone cysts by percutaneous CT-guided injection of calcitonin and steroid. Skeletal Radiol. 2017;46(1):35–40.CrossRefPubMedCentralGoogle Scholar
  6. 6.
    Woodrum DA, Kawashima A, Karnes RJ, et al. Magnetic resonance imaging-guided cryoablation of recurrent prostate cancer after radical prostatectomy: initial single institution experience. Urology. 2013;82(4):870–5.CrossRefPubMedCentralGoogle Scholar
  7. 7.
    Joshi DH, Thawait GK, Del Grande F, Fritz J. MRI-guided cryoablation of the posterior femoral cutaneous nerve for the treatment of neuropathy-mediated sitting pain. Skeletal Radiol. 2017;46(7):983–7.CrossRefPubMedCentralGoogle Scholar
  8. 8.
    O’Donnell P, Saifuddin A. The prevalence and diagnostic significance of fluid-fluid levels in focal lesions of bone. Skeletal Radiol. 2004;33(6):330–6.CrossRefPubMedCentralGoogle Scholar
  9. 9.
    Cottalorda J, Bourelle S. Current treatments of primary aneurysmal bone cysts. J Pediatr Orthop B. 2006;15(3):155–67.CrossRefPubMedCentralGoogle Scholar
  10. 10.
    Gibbs CP Jr, Hefele MC, Peabody TD, Montag AG, Aithal V, Simon MA. Aneurysmal bone cyst of the extremities. Factors related to local recurrence after curettage with a high-speed burr. J Bone Joint Surg Am. 1999;81(12):1671–8.CrossRefPubMedCentralGoogle Scholar
  11. 11.
    Peeters SP, Van der Geest IC, de Rooy JW, Veth RP, Schreuder HW. Aneurysmal bone cyst: the role of cryosurgery as local adjuvant treatment. J Surg Oncol. 2009;100(8):719–24.CrossRefPubMedCentralGoogle Scholar
  12. 12.
    Ferrer-Mileo L, Luque Blanco AI, Gonzalez-Barboteo J. Efficacy of cryoablation to control cancer pain: a systematic review. Pain Pract. 2018. Scholar
  13. 13.
    Griauzde J, Gemmete JJ, Farley F. Successful treatment of a musculoskeletal tumor society grade 3 aneurysmal bone cyst with N-butyl cyanoacrylate embolization and percutaneous cryoablation. J Vasc Interv Radiol. 2015;26(6):905–9.CrossRefPubMedCentralGoogle Scholar
  14. 14.
    Tsoumakidou G, Too CW, Garnon J, Steib JP, Gangi A. Treatment of a spinal aneurysmal bone cyst using combined image-guided cryoablation and cementoplasty. Skeletal Radiol. 2015;44(2):285–9.CrossRefPubMedCentralGoogle Scholar
  15. 15.
    Fritz J, U-Thainual P, Ungi T, et al. MR-guided vertebroplasty with augmented reality image overlay navigation. Cardiovasc Intervent Radiol. 2014;37(6):1589–96.CrossRefPubMedCentralGoogle Scholar

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© ISS 2018

Authors and Affiliations

  1. 1.Russell H. Morgan Department of Radiology and Radiological Science, Section of Musculoskeletal RadiologyJohns Hopkins University School of MedicineBaltimoreUSA
  2. 2.Department of Diagnostic and Interventional RadiologyHannover Medical SchoolHannoverGermany
  3. 3.Research Campus STIMULATEHannoverGermany
  4. 4.Department of Orthopaedic SurgeryJohns Hopkins University School of MedicineBaltimoreUSA

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