Radiofrequency ablation:
Done under CT guidance
11 G radiofrequency-compatible coaxial needle
2 mm coaxial drill system
1.0 cm active tip 17 G non-cooled radiofrequency needle
At 90 °C for 6 min.
Absolute alcohol injection:
Usually after RFA
0.5–1.0 ml absolute alcohol into the nidus using 20 G needle
Prognosis:
Technical success rate 100%
Pain relief in 96%
Complications:
Rare
Local cellulitis
Paresthesia
Reference:
Akhlaghpoor S et al. Percutaneous osteoid osteoma treatment with combination of radiofrequency and alcohol ablation. Clin Rad (2007). 62: 268-273
Showing posts with label radiofrequency ablation. Show all posts
Showing posts with label radiofrequency ablation. Show all posts
Journal watch: Osteoid osteoma
Percutaneous combination therapy of radiofrequency and alcohol ablation in osteoid osteoma is very effective
Clin Rad (2007). 62: 268-273
Akhlaghpoor S et al (Clinical Radiology 2007. 62:268-273 ) from Noor Medical Imaging Center, Iran treated 54 patients od osteoid osteoma with 11 G radiofrequency-compatible coaxial needle and 2 mm coaxial drill system and 1.0 cm active tip 17 G non-cooled radiofrequency needle. They performed RFA at 90 °C for 6 min. After needle removal, they injected 0.5–1.0 ml absolute alcohol into the nidus using a 20 G needle. The patients were discharged within 24 h.
They claim technical success rate of 100%. Complications occurred in about 4% (2 patients) and they were mild local cellulitis and small zone peripheral paresthesia. The follow-up period was in the range of 13–48 months. Pain relief and return to normal activities were seen in 52 of 54 patients (96%). Pain recurred in 2 patients after 1 and 3 months of pain free period. A second RFA and alcohol ablation was performed achieving successful results.
They concluded that the percutaneous osteoid osteoma treatment with combination of radiofrequency and alcohol ablation was effective with high success rate and also persistent or recurrent lesions could be effectively re-treated.
Clin Rad (2007). 62: 268-273
Akhlaghpoor S et al (Clinical Radiology 2007. 62:268-273 ) from Noor Medical Imaging Center, Iran treated 54 patients od osteoid osteoma with 11 G radiofrequency-compatible coaxial needle and 2 mm coaxial drill system and 1.0 cm active tip 17 G non-cooled radiofrequency needle. They performed RFA at 90 °C for 6 min. After needle removal, they injected 0.5–1.0 ml absolute alcohol into the nidus using a 20 G needle. The patients were discharged within 24 h.
They claim technical success rate of 100%. Complications occurred in about 4% (2 patients) and they were mild local cellulitis and small zone peripheral paresthesia. The follow-up period was in the range of 13–48 months. Pain relief and return to normal activities were seen in 52 of 54 patients (96%). Pain recurred in 2 patients after 1 and 3 months of pain free period. A second RFA and alcohol ablation was performed achieving successful results.
They concluded that the percutaneous osteoid osteoma treatment with combination of radiofrequency and alcohol ablation was effective with high success rate and also persistent or recurrent lesions could be effectively re-treated.
Tumour & tumour like: Osteoid osteoma (OO)
General:
Osteoblastic tumour with central core of vascular osteiod tissue (nidus - usually 1-10mm) with peripheral sclerotic reactive bone
10–12% of benign bone tumors
First 2 decades of life in 70%, in children and young adults
Male:female = 1.6:1
50% in femur and tibia
Clinical features:
Hallmark is night pain relieved by aspirin
Plain radiograph:
Radiolucent nidus with thick sclerotic rim
CT:
Low attenuation nidus with possible internal calcification and variable surrounding sclerosis
MRI:
Low-to-intermediate signal T1WI, variable signal on T2WI
Variable enhancement on Gd
May be misleading due to marrow and soft tissue edema
Often leads to misdiagnosis of osteomyelitis, stress fracture, inflammatory arthritis, or aggressive bone tumor
Bone scan:
Bone scan shows double density sign
Oteoid osteoma and osteoblastoma:
OO - Nidus less than 15 mm ; OB - nidus more than 15 mm
Treatment:
CT guided RFA with ot without absolute alcohol
OO of rib:
Most occur posteriorly
Scloliosis
OO of foot:
4% of cases
Most common site is talus
75% juxta-articular
OO of spine:
Most common in neural arch
Most common in lumbar spine
Present with painful scoliosis
Bone scan is most sensitive and almost always positive
After bone scan, perform CT for localization of nidus
MR - not very good tool, variable signal on T1 and T2, most enhance with Gd
References:
1. Hughes et al. Benign primary tumours of the ribs. Clin rad (2006): 61:314-322
2. Lee GK et al. Osteoid Osteoma of the Tarsal Cuboid Mimicking Osteomyelitis. AJR 2004; 183:341-342
3. Rodallec MH et al. Diagnostic Imaging of Solitary Tumors of the Spine: What to Do and Say. RadioGraphics 2008;28:1019-1041
JOURNAL WATCH:
Click Here
Osteoblastic tumour with central core of vascular osteiod tissue (nidus - usually 1-10mm) with peripheral sclerotic reactive bone
10–12% of benign bone tumors
First 2 decades of life in 70%, in children and young adults
Male:female = 1.6:1
50% in femur and tibia
Clinical features:
Hallmark is night pain relieved by aspirin
Plain radiograph:
Radiolucent nidus with thick sclerotic rim
CT:
Low attenuation nidus with possible internal calcification and variable surrounding sclerosis
MRI:
Low-to-intermediate signal T1WI, variable signal on T2WI
Variable enhancement on Gd
May be misleading due to marrow and soft tissue edema
Often leads to misdiagnosis of osteomyelitis, stress fracture, inflammatory arthritis, or aggressive bone tumor
Bone scan:
Bone scan shows double density sign
Oteoid osteoma and osteoblastoma:
OO - Nidus less than 15 mm ; OB - nidus more than 15 mm
Treatment:
CT guided RFA with ot without absolute alcohol
OO of rib:
Most occur posteriorly
Scloliosis
OO of foot:
4% of cases
Most common site is talus
75% juxta-articular
OO of spine:
Most common in neural arch
Most common in lumbar spine
Present with painful scoliosis
Bone scan is most sensitive and almost always positive
After bone scan, perform CT for localization of nidus
MR - not very good tool, variable signal on T1 and T2, most enhance with Gd
References:
1. Hughes et al. Benign primary tumours of the ribs. Clin rad (2006): 61:314-322
2. Lee GK et al. Osteoid Osteoma of the Tarsal Cuboid Mimicking Osteomyelitis. AJR 2004; 183:341-342
3. Rodallec MH et al. Diagnostic Imaging of Solitary Tumors of the Spine: What to Do and Say. RadioGraphics 2008;28:1019-1041
JOURNAL WATCH:
Click Here
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