Interventional radiology is today considered the first-line treatment for osteoid osteoma both in the form of needle-guided technique of ablation (Radiofrequency) and of needleless technique (magnetic resonance-guided focused ultrasound surgery). The follow-up study of the procedures is mainly clinical, since the disappearance of pain is consistent with the success of the procedure. However, due to the minimally invasive and innovative nature of the approach, interpretation of the follow-up imaging could be ambiguous and misleading. Aim of our review was to define the main findings on the imaging that can best describe the regular evolution of these types of treatment. In particular, four findings were considered: (1) bone marrow oedema; (2) reactive phenomena (perilesional inflammatory reaction for extra-articular lesions or synovial reaction for intra-articular lesions); (3) bone remodelling (disappearance of the nidus and bone healing); (4) ring sign (considered as the granulation tissue around the nidus treated). These findings were evaluated using MRI and CT with a follow-up study that lasted up to 24 months.
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Karagöz E, Özel D, Özkan F, Özel BD, Özer Ö, Coşkun ZÜ (2016) Effectiveness of computed tomography guided percutaneous radiofrequency ablation therapy for osteoid osteoma: initial results and review of the literature. Pol J Radiol 81:295–300. https://doi.org/10.12659/PJR.896475
Von Engelhardt LV, El Tabbakh MR, Engers R, Lahner M, Jerosch J (2016) Hip arthroscopy for excision of osteoid osteoma and for the application of a collagen cartilage implant: case report in a professional athlete, and literature review. Technol Health Care 24(6):957–964. https://doi.org/10.3233/THC-161223
Mutlu H, Yaldiz H, Mutlu S, Cetinkaya E, Cepni K, Armagan A et al (2014) Atypical location of an osteoid osteoma with atypical anterior knee pain. Int J Surg Case Rep 5(11):873–876. https://doi.org/10.1016/j.ijscr.2014.10.015
Hamada T, Matsubara H, Kimura H, Aikawa T, Yoshida Y, Tsuchiya H (2016) Intra-articular osteoid osteoma of the calcaneus: a case report and review. Radiol Case Rep 11(3):212–216. https://doi.org/10.1016/j.radcr.2016.05.008
Gaeta M, Minutoli F, Pandolfo I, Vinci S, D’Andrea L, Blandino A (2004) Magnetic resonance imaging findings of osteoid osteoma of the proximal femur. Eur Radiol 14(9):1582–1589. https://doi.org/10.1007/s00330-004-2293-5
Chai JW, Hong SH, Choi J-Y, Koh YH, Lee JW, Choi J-A et al (2010) Radiologic diagnosis of osteoid osteoma: from simple to challenging findings. Radio Graph 30(3):737–749. https://doi.org/10.1148/rg.303095120
Song MH, Yoo WJ, Cho TJ, Chung CY, Park MS, Cheon JE et al (2015) Clinical and radiological features and skeletal sequelae in childhood intra-/juxta-articular versus extra-articular osteoid osteoma. BMC Musculoskelet Disord 16(1):1–6. https://doi.org/10.1186/s12891-015-0456-y
Rosenthal DI, Hornicek FJ, Torriani M, Gebhardt MC, Mankin HJ (2003) Radiology osteoid osteoma: percutaneous treatment with radiofrequency energy. Radiology 2:171–175. https://doi.org/10.1148/radiol.2291021053
Arrigoni F, Napoli A, Bazzocchi A, Zugaro L, Scipione R, Bruno F et al (2019) Magnetic-resonance-guided focused ultrasound treatment of non-spinal osteoid osteoma in children: multicentre experience. Pediatr Radiol 49:1209–1216. https://doi.org/10.1007/s00247-019-04426-0
Masciocchi C, Zugaro L, Arrigoni F, Gravina GL, Mariani S, La Marra A et al (2016) Radiofrequency ablation versus magnetic resonance guided focused ultrasound surgery for minimally invasive treatment of osteoid osteoma: a propensity score matching study. Eur Radiol 26:2472–2481. https://doi.org/10.1007/s00330-015-4111-7
Hoffmann RT, Jakobs TF, Kubisch CH, Trumm CG, Weber C, Duerr HR et al (2010) Radiofrequency ablation in the treatment of osteoid osteoma-5-year experience. Eur J Radiol 73(2):374–379. https://doi.org/10.1016/j.ejrad.2008.11.018
Temple MJ, Waspe AC, Amaral JG, Napoli A, LeBlang S, Ghanouni P et al (2016) Establishing a clinical service for the treatment of osteoid osteoma using magnetic resonance-guided focused ultrasound: overview and guidelines. J Ther Ultrasound 4(1):1–11. https://doi.org/10.1186/s40349-016-0059-6
Arrigoni F, Bruno F, Palumbo P, Zugaro L, Zoccali C, Barile A et al (2019) Magnetic resonance-guided focused ultrasound surgery treatment of non-spinal intra-articular osteoblastoma: feasibility, safety, and outcomes in a single-center retrospective analysis. Int J Hyperth 36(1):768–775. https://doi.org/10.1080/02656736.2019.1639833
Napoli A, Bazzocchi A, Scipione R, Anzidei M, Saba L, Cozzi AD et al (2017) Noninvasive therapy for osteoid osteoma: a prospective developmental study with MR imaging-guided high-intensity focused ultrasound. Radiology 285(1):186–196
Rehnitz C, Sprengel SD, Lehner B, Ludwig K, Omlor G, Merle C et al (2012) CT-guided radiofrequency ablaton of osteoid osteoma: correlation of clinical outcome and imaging features. Diagn Interv Radiol 2013(19):330–339. https://doi.org/10.5152/dir.2013.096
Albisinni U, Facchini G, Spinnato P, Gasbarrini A, Bazzocchi A (2017) Spinal osteoid osteoma: efficacy and safety of radiofrequency ablation. Skeletal Radiol 46:1087–1094. https://doi.org/10.1007/s00256-017-2662-1
Lassalle L, Campagna R, Corcos G, Babinet A, Larousserie F (2017) Therapeutic outcome of CT-guided radiofrequency ablation in patients with osteoid osteoma. Skeletal Radiol 46:949–956. https://doi.org/10.1007/s00256-017-2658-x
Esteban H, Martel J, Bueno A, Kassarjian A, Rodriguez G (2018) Percutaneous radiofrequency ablation in osteoid ostema: tips and tricks in special scenarios. Eur J Radiol 102(February):169–175. https://doi.org/10.1016/j.ejrad.2018.03.008
Erba G, Şendur HN, Kiliç HK, Cindil E, Öner AY, Tokgöz N (2019) Treatment-related alterations of imaging findings in osteoid osteoma after percutaneous radiofrequency ablation. Skeletal Radiol 48(11):1697–1703
Masciocchi C, Arrigoni F, La Marra A, Mariani S, Zugaro L, Barile A (2016) Treatment of focal benign lesions of the bone: MRgFUS and RFA. Br J Radiol 89(1066):20150356. https://doi.org/10.1259/bjr.20150356
Weber MA, Sprengel SD, Omlor GW, Lehner B, Wiedenhöfer B, Kauczor HU et al (2015) Clinical long-term outcome, technical success, and cost analysis of radiofrequency ablation for the treatment of osteoblastomas and spinal osteoid osteomas in comparison to open surgical resection. Skeletal Radiol 44(7):981–993. https://doi.org/10.1007/s00256-015-2139-z
Abboud S, Kosmas C, Novak R, Robbin M (2016) Long-term clinical outcomes of dual-cycle radiofrequency ablation technique for treatment of osteoid osteoma. Skeletal Radiol 45(5):599–606. https://doi.org/10.1007/s00256-015-2321-3
Wu H, Lu C, Chen M (2017) Evaluation of minimally invasive laser ablation in children with osteoid osteoma. Oncol Lett 13(1):155–158. https://doi.org/10.3892/ol.2016.5417
Authors wish to thank Angela Martella for translating the manuscript.
This work has not been supported by any funding.
Conflict of interest
All authors declare that they have no conflict of interest.
All the clinical procedures described in the study were performed in accordance with the Helsinki declaration and patients signed an informed consent.
This article is a retrospective study. It is based on results of standardized therapeutic treatments (non-experimental). All patients signed a informed consent.
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Arrigoni, F., Bruno, F., Gianneramo, C. et al. Evolution of the imaging features of osteoid osteoma treated with RFA or MRgFUS during a long-term follow-up: a pictorial review with clinical correlations. Radiol med (2020). https://doi.org/10.1007/s11547-020-01134-w
- Osteoid osteoma
- Bone ablation
- Ablation follow-up
- Interventional radiology