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Magnetic-resonance-guided focused ultrasound treatment of non-spinal osteoid osteoma in children: multicentre experience



Osteoid osteoma is a benign and painful musculoskeletal tumour that usually affects children. Current standard treatment is CT-guided radiofrequency ablation, a minimally invasive percutaneous procedure, with clinical success rates ranging between 85% and 98%. Though minimally invasive, however, this type of procedure is not free from complications.


To investigate the efficacy and safety of magnetic resonance (MR)-guided focused ultrasound (MRgFUS), a needleless procedure of thermal ablation employed in the treatment of non-spinal osteoid osteoma in paediatric patients.

Materials and methods

We report the results of 33 procedures of ablation of osteoid osteoma performed with MRgFUS in three university hospitals. To ablate a lesion on the bone surface, MRgFUS employs the ultrasound energy transduced along the soft tissue. The follow-up studies lasted 24 months and were performed combining clinical and imaging data.


Mean age of the children was 13.8 years. The clinical outcome showed a primary success of 97%. One case alone was submitted to repeat treatment because the first one failed (secondary success). No major or minor complications were recorded. During the investigation time, no relapse of symptomatology or delayed complications were observed.


Although our study is preliminary and limited by a low number of patients, our data show that MRgFUS is effective. This suggests that it might be useful as the first-line treatment in paediatric patients with osteoid osteoma.

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  1. Campanacci M (1981) In: Gaggi A (ed) Bone and soft tissue tumors, Vol. 1, Bologna

  2. Graham GN, Browne H (2001) Primary bony tumours of the pediatric spine. Yale J Biol Med 74:1–8

    CAS  PubMed  PubMed Central  Google Scholar 

  3. Rehnitz C, Sprengel SD, Lehner B et al (2013) CT-guided radiofrequency ablation of osteoid osteoma: correlation of clinical outcome and imaging features. Diagn Interv Radiol 19:330–339

    PubMed  Google Scholar 

  4. Lanza E, Thouvenin Y, Viala P et al (2013) Osteoid osteoma treated by percutaneous thermal ablation: when do we fail? A systematic review and guidelines for future reporting. Cardiovasc Intervent Radiol 37:1530–1539

    Article  PubMed  Google Scholar 

  5. Natali GL, Paolantonio G, Fruhwirth R et al (2016) Paediatric musculoskeletal interventional radiology. Br J Radiol 89:20150369

    Article  PubMed  Google Scholar 

  6. Arrigoni F, Barile A, Zugaro L et al (2017) CT-guided radiofrequency ablation of spinal osteoblastoma: treatment and long-term follow-up. Int J Hyperth 9:1–7

    Google Scholar 

  7. Masciocchi C, Conchiglia A, Gregori LM et al (2014) Critical role of HIFU in musculoskeletal interventions. Radiol Med 119:470–475

    Article  PubMed  Google Scholar 

  8. Arrigoni F, Gregori LM, Zugaro L et al (2014) MRgFUS in the treatment of MSK lesions: a review based on the experience of the University of L’Aquila. Transl Cancer Res.

  9. Arrigoni F, Barile A, Zugaro L et al (2017) Intra-articular benign bone lesions treated with magnetic resonance-guided focused ultrasound (MRgFUS): imaging follow-up and clinical results. Med Oncol 34:55

    Article  PubMed  Google Scholar 

  10. Barile A, Arrigoni F, Zugaro L et al (2017) Minimally invasive treatments of painful bone lesions: state of the art. Med Oncol 34:53

    Article  PubMed  Google Scholar 

  11. Masciocchi C, Arrigoni F, La Marra A et al (2016) Treatment of focal benign lesions of the bone: MRgFUS and RFA. Br J Radiol 89:20150356

    Article  PubMed  PubMed Central  Google Scholar 

  12. Napoli A, Mastantuono M, Cavallo Marincola B et al (2013) Osteoid osteoma: MR-guided focused ultrasound for entirely noninvasive treatment. Radiology 267:514–521

    Article  PubMed  Google Scholar 

  13. Geiger D, Napoli A, Conchiglia A et al (2014) MR-guided focused ultrasound (MRgFUS) ablation for the treatment of nonspinal osteoid osteoma: a prospective multicenter evaluation. J Bone Joint Surg Am 96:743–751

    Article  CAS  PubMed  Google Scholar 

  14. Masciocchi C, Zugaro L, Arrigoni F 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

    Article  PubMed  Google Scholar 

  15. Bazzocchi A, Napoli A, Sacconi B et al (2016) MRI-guided focused ultrasound surgery in musculoskeletal diseases: the hot topics. Br J Radiol 89:20150358

    Article  PubMed  Google Scholar 

  16. Ministero della Salute: Progetto Mattoni SSN (2007) Evolution of the (Italian) national DRG system: New Pediatric classification

  17. Caramia G (2011) Age limit and hospitalization in pediatric wards. The problem of adolescence. Acts of the IV National Congress of the Italian Pediatric Society of hospital doctors

  18. Stinson J, Kavanagh T, Yamada J et al (2006) Systematic review of the psychometric properties, interpretability and feasibility of self-report pain intensity measures for use in clinical trials in children and adolescents. Pain 125:143–157

    Article  PubMed  Google Scholar 

  19. Campanacci M, Ruggieri P, Gasbarrini A et al (1999) Osteoid osteoma direct visual identification and intralesional excision of the nidus with minimal removal of bone. J Bone Joint Surg Br 81:814–820

    Article  CAS  PubMed  Google Scholar 

  20. Rosenthal DI, Hornicek FJ, Torriani M et al (2003) Osteoid osteoma: percutaneous treatment with radiofrequency energy. Radiology 229:171–175

    Article  PubMed  Google Scholar 

  21. Sharma KV, Yarmolenko PS, Celik H et al (2017) Comparison of noninvasive high-intensity focused ultrasound with radiofrequency ablation of osteoid osteoma. J Pediatr 190:222–228

    Article  PubMed  Google Scholar 

  22. Yarmolenko PS, Eranki A, Partanen A et al (2018) Technical aspects of osteoid osteoma ablation in children using MR-guided high intensity focussed ultrasound. Int J Hyperth 34:49–58

    Article  Google Scholar 

  23. Ahmed M, Solbiati L, Brace CL et al (2014) Image-guided tumor ablation: standardization of terminology and reporting criteria—a 10-year update. Radiology 273:241–260

    Article  PubMed  PubMed Central  Google Scholar 

  24. Napoli A, Bazzocchi A, Scipione R et al (2017) Noninvasive therapy for osteoid osteoma: a prospective developmental study with MR imaging–guided high-intensity focused ultrasound. Radiology 285:186–196

    Article  PubMed  Google Scholar 

  25. Ghanem I, Collet LM, Kharrat K et al (2003) Percutaneous radiofrequency coagulation of osteoid osteoma in children and adolescents. J Pediatr Orthop 12:244–252

    Google Scholar 

  26. Sierre S, Innocenti S, Lipsich J et al (2006) Percutaneous treatment of osteoid osteoma by CT-guided drilling resection in pediatric patients. Pediatr Radiol 36:115

    Article  PubMed  Google Scholar 

  27. Moser T, Giacomelli MC, Clavert JM et al (2008) Image-guided laser ablation of osteoid osteoma in pediatric patients. J Pediatr Orthop 28:265–270

    Article  PubMed  Google Scholar 

  28. Kayser F, Resnick D, Haghighi P et al (1998) Evidence of the subperiosteal origin of osteoid osteomas in tubular bones: analysis by CT and MR imaging. AJR Am J Roentgenol 170:609–614

    Article  CAS  PubMed  Google Scholar 

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We thank Angela Martella for translating the manuscript.

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Correspondence to Francesco Arrigoni.

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Arrigoni, F., Napoli, A., Bazzocchi, A. et al. Magnetic-resonance-guided focused ultrasound treatment of non-spinal osteoid osteoma in children: multicentre experience. Pediatr Radiol 49, 1209–1216 (2019).

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  • Adolescents
  • Bone
  • Children
  • Magnetic-resonance-guided focused ultrasound
  • Osteoid osteoma