Osteoid osteoma: multimodality imaging with focus on hybrid imaging

  • Ujwal Bhure
  • Justus E. Roos
  • Klaus StrobelEmail author
Review Article


Osteoid osteoma is a painful, benign, osteoblastic lesion that occurs in younger patients and affects the extremities or the axial skeleton. While plain film findings may suggest the diagnosis, in complex anatomical regions such as the spine, pelvis, wrist and foot advanced imaging modalities are often required. A typical nidus surrounded by sclerosis or cortical thickening characterizes osteoid osteoma on plain radiography and CT. MR is the cross-sectional imaging modality of choice for most musculoskeletal disorders. Unfortunately, extensive accompanying bone marrow oedema, soft-tissue alterations, difficulty detecting the nidus, and lesion locations close to a joint (with reactive arthritis) may make a confident diagnosis of osteoid osteoma by MR imaging difficult. Hybrid imaging with bone-seeking tracers such as SPECT/CT with 99mTc-labelled bisphosphonates or PET/CT with 18F-labelled sodium fluoride (18F-NaF) combines high radionuclide uptake with morphological details and provides accurate diagnosis of osteoid osteoma and additional information for treatment planning. FDG is not the recommended PET tracer because osteoid osteoma is normally FDG-negative, although some osteoid osteomas may show increased FDG uptake. Osteoblastoma, Brodie’s abscess and stress fractures may mimic osteoid osteoma on imaging and clinical presentation. Once identified as the pain generator, destruction of the osteoid osteoma nidus by ablation or resection techniques usually leads to complete healing. Image-guided drill excision and radiofrequency ablation are widely used interventions. We review the presentation of osteoid osteoma across all imaging modalities, with special focus on hybrid imaging techniques.


Osteoid osteoma Hybrid imaging SPECT/CT MR PET/CT Bone scintigraphy 



Figure 12: Image courtesy of Dr. Alessio Imperiale, Nuclear Medicine, University Hospital Strasbourg, France.

Figure 13: Image courtesy of Dr. Joachim Müller, Nuclear Medicine, Cantonal Hospital St. Gallen, Switzerland.

Figures 7 and 9: Image design courtesy of Lutz Lehmann, Luzerner Kantonsspital, Luzern, Switzerland.

Authors’ contributions

All authors contributed in a significant way to the content and revision of this manuscript. All authors read and approved the final manuscript.

Compliance with ethical standards

Conflicts of interest


Ethical approval and consent to participate

Not applicable.

Consent to publication

Not applicable.


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© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Radiology and Nuclear MedicineCantonal Hospital LucerneLucerneSwitzerland

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