Skip to main content

Advertisement

SpringerLink
Log in

Role of percutaneous CT–guided radiofrequency ablation in treatment of intra-articular, in close contact with cartilage and extra-articular osteoid osteomas: comparative analysis and new classification system

  • Diagnostic Imaging in Oncology
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Purpose

We investigated procedural safety, technical and clinical outcomes of the percutaneous image-guided radiofrequency ablation (PRFA) of intra-articular (IA), intra-articular close to cartilage (IACC), and extra-articular (EA) osteoid osteomas (OO). We proposed a new radiologic classification for osteoid osteoma depending on the degree and location of sclerosis which may correlate with technical failure and/or difficulties.

Material and methods

According to the inclusion criteria, we enrolled consecutive patients who were referred to the investigation center from June 2018 to January 2022. After clinical and CT imaging features were suggestive for the diagnosis of OO, all the patients were treated by percutaneous CT-guided RFA with a standardized technique. Biopsy of the lesion was not performed in all patients. A retrospective analysis was conducted to assess the procedure’s technical, primary clinical, and secondary clinical successes, recurrence rate, and complications. We classified all the OOs according to a new proposed classification of the site and the amount of sclerosis.

Results

A total number of 55 patients were enrolled in our study according to the inclusion criteria. The mean age of the enrolled patients was 24.07 ± 14.71 years (ranges from 7 to 57 years). The M/F ratio was roughly 2:1. The mean follow-up was 20.18 ± 12.60 months (ranges from 2 to 44 months). EA group included 36 patients, IA included 5 and IACC included 14 patients. Technical success was achieved in all cases of IA and IACC groups. Technical success in the EA group was 97.22% (1 technical failure). Primary clinical success was 100%, 92.85%, and 91.66% for IA, IACC, and EA groups, respectively. Accordingly, the recurrence rate was 5.88% in EA, and 7.14% in IACC, while no recurrence occurred in the IA group. No complications occurred. The secondary success rate of the 3 cases of recurrence was 100%.

Conclusions

PRFA proved to be a safe procedure with a high rate of success for OO treatment even in intra-articular lesions in close contact with cartilage. This study showed that the results in terms of technical and clinical success are comparable for IA OO, IACC OO, and EA OO, even if the recurrence rate was higher in EA OO. Our proposed new classification of the degree and location of sclerosis may correlate to technical failure, but further studies with a larger number of patients are needed for validation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Abbreviations

PRFA:

Percutaneous radiofrequency ablation

CT:

Computed tomography

OO:

Osteoid osteoma

NSAIDs:

Nonsteroidal anti-inflammatory drugs

IA:

Intra-articular

IACC:

Intra-articular close to the cartilage

EA:

Extra-articular

References

  1. Noordin S, Allana S, Hilal K, Nadeem N, Lakdawala R, Sadruddin A et al (2018) Osteoid osteoma: contemporary management. Orthop Rev (Pavia) 10(3):108–119

    Article  Google Scholar 

  2. Yuce G, Aytekin N, Eren S, Genç B, Ateş ÖF, Canyiğit M (2020) Is radiofrequency ablation safe and effective in treating osteoid osteomas? A prospective single-center study with atypical cases. J Orthop Surg 28(3):1–7

    Article  Google Scholar 

  3. Bellisari FC, Palumbo P, Masciocchi C, Zoccali C, Barile A, Arrigoni F (2022) Needleless ablation of osteoid osteoma and osteoblastoma: the emergent role of MRgfUS. J Clin Med 11(1):128

    Article  Google Scholar 

  4. Tepelenis K, Skandalakis GP, Papathanakos G, Kefala MA, Kitsouli A, Barbouti A et al (2021) Osteoid osteoma: an updated review of epidemiology, pathogenesis, clinical presentation, radiological features, and treatment option. In Vivo (Brooklyn) 35(4):1929–1938

    Article  CAS  Google Scholar 

  5. De Filippo M, Russo U, Papapietro VR, Ceccarelli F, Pogliacomi F, Vaienti E et al (2018) Radiofrequency ablation of osteoid osteoma. Acta Biomed 89:175–185

    PubMed  PubMed Central  Google Scholar 

  6. Arrigoni F, Izzo A, Bruno F, Palumbo P, De Filippo M, Zugaro L et al (2021) Musculoskeletal interventional radiology in the pediatric population: state of the art. Semin Musculoskelet Radiol 25(1):176–183

    Article  Google Scholar 

  7. 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(9):1209–1216

    Article  Google Scholar 

  8. Carneiro BC, Da Cruz IAN, Ormond Filho AG, Silva IP, Guimarães JB, Silva FD et al (2021) Osteoid osteoma: the great mimicker. Insights Imaging [Internet]. https://doi.org/10.1186/s13244-021-00978-8

    Article  Google Scholar 

  9. Singh DK, Katyan A, Kumar N, Nigam K, Jaiswal B, Misra RN (2020) CT-guided radiofrequency ablation of osteoid osteoma: Established concepts and new ideas. Br J Radiol 93(1114):1–12

    Article  Google Scholar 

  10. Filippiadis DK, Velonakis G, Kostantos C, Kouloulias V, Brountzos E, Kelekis N et al (2017) Computed tomography-guided radiofrequency ablation of intra-articular osteoid osteoma: a single centre’s experience. Int J Hyperth 28:670–674

    Article  Google Scholar 

  11. Parmeggiani A, Martella C, Ceccarelli L, Miceli M, Spinnato P, Facchini G (2021) Osteoid osteoma: which is the best mininvasive treatment option? Eur J Orthop Surg Traumatol [Internet]. 31(8):1611–1624. https://doi.org/10.1007/s00590-021-02946-w

    Article  PubMed  PubMed Central  Google Scholar 

  12. Huang AJ (2016) Radiofrequency ablation of osteoid osteoma: difficult-to-reach places. Semin Musculoskelet Radiol 20(5):486–495

    Article  Google Scholar 

  13. Arrigoni F, Bruno F, Gianneramo C, Palumbo P, Zugaro L, Zoccali C et al (2020) 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 [Internet]. 125(6):578–584. https://doi.org/10.1007/s11547-020-01134-w

    Article  PubMed  Google Scholar 

  14. Fiore F, Somma F, D’Angelo R, Tarotto L, Stoia V (2022) Cone beam computed tomography (CBCT) guidance is helpful in reducing dose exposure to pediatric patients undergoing radiofrequency ablation of osteoid osteoma. Radiol Medica [Internet]. 127(2):183–190. https://doi.org/10.1007/s11547-021-01439-4

    Article  Google Scholar 

  15. Esteban Cuesta H, Martel Villagran J, Bueno Horcajadas A, Kassarjian A, Rodriguez CG (2018) Percutaneous radiofrequency ablation in osteoid ostema: Tips and tricks in special scenarios. Eur J Radiol [Internet]. 102(February):169–175. https://doi.org/10.1016/j.ejrad.2018.03.008

    Article  PubMed  Google Scholar 

  16. Papagelopoulos PJ, Mavrogenis AF, Kyriakopoulos CK, Benetos IS, Kelekis NL, Andreou J et al (2006) Radiofrequency ablation of intra-articular osteoid osteoma of the hip. J Int Med Res 34(5):537–544

    Article  CAS  Google Scholar 

  17. Garge S, Keshava SN, Moses V, Chiramel GK, Ahmed M, Mammen S et al (2017) Radiofrequency ablation of osteoid osteoma in common and technically challenging locations in pediatric population. Indian J Radiol Imaging 27(1):88–91

    Article  Google Scholar 

  18. Mylona S, Patsoura S, Galani P, Karapostolakis G, Pomoni A, Thanos L (2010) Osteoid osteomas in common and in technically challenging locations treated with computed tomography-guided percutaneous radiofrequency ablation. Skeletal Radiol 39(5):443–449

    Article  Google Scholar 

  19. Filippiadis D, Gkizas C, Kostantos C, Mazioti A, Reppas L, Brountzos E et al (2016) Percutaneous biopsy and radiofrequency ablation of osteoid osteoma with excess reactive new bone formation and cortical thickening using a battery-powered drill for access: a technical note. Cardiovasc Intervent Radiol 39(10):1499–1505

    Article  CAS  Google Scholar 

  20. Arrigoni F, Izzo A, Bruno F, Zugaro L, Arrigoni G, Vacca F et al (2021) Could anaesthesia be a key factor for the good outcome of bone ablation procedures? A retrospective analysis of a musculoskeletal interventional centre. Br J Radiol 94(1118):20200937

    Article  Google Scholar 

  21. Ahmed M (2014) Image-guided tumor ablation: standardization of terminology and reporting criteria-A 10-year update. Radiology 273(1):241–260

    Article  Google Scholar 

  22. Sacks D, McClenny TE, Cardella JF, Lewis CA (2003) Society of interventional radiology clinical practice guidelines. J Vasc Interv Radiol 14(9):S199-202

    Article  Google Scholar 

  23. Filippiadis DK, Binkert C, Pellerin O, Hoffmann RT, Krajina A, Pereira PL (2017) Cirse quality assurance document and standards for classification of complications: the cirse classification system. Cardiovasc Intervent Radiol 40(8):1141–1146

    Article  CAS  Google Scholar 

  24. Germann T, Weber MA, Lehner B, Kintzele L, Burkholder I, Kauczor HU et al (2020) Das intraartikuläre osteoidosteom: mrt-charakteristik und klinisches erscheinungsbild vor und nach radiofrequenzablation im vergleich zum extraartikulären osteoidosteom. Rofo 192(12):1190–1199

    PubMed  Google Scholar 

  25. Arrigoni F, Spiliopoulos S, de Cataldo C, Reppas L, Palumbo P, Mazioti A et al (2021) A bicentric propensity score matched study comparing percutaneous computed tomography-guided radiofrequency ablation to magnetic resonance-guided focused ultrasound for the treatment of osteoid osteoma. J Vasc Interv Radiol [Internet]. 32(7):1044–1051. https://doi.org/10.1016/j.jvir.2021.03.528

    Article  PubMed  Google Scholar 

  26. Barile A, Arrigoni F, Bruno F, Palumbo P, Floridi C, Cazzato RL et al (2018) Present role and future perspectives of interventional radiology in the treatment of painful bone lesions. Fut Oncol 14(28):2945–2955

    Article  CAS  Google Scholar 

  27. Sgalambro F, Zugaro L, Bruno F, Palumbo P, Salducca N, Zoccali C et al (2022) Interventional radiology in the management of metastases and bone tumors. J Clin Med 11(12):3265

    Article  Google Scholar 

  28. Rosenthal DI, Hornicek FJ, Torriani M, Gebhardt MC, Mankin HJ (2003) Osteoid osteoma: percutaneous treatment with radiofrequency energy. Radiology 229(1):171–175

    Article  Google Scholar 

  29. Irastorza RM, Trujillo M, Martel Villagrán J, Berjano E (2016) Computer modelling of RF ablation in cortical osteoid osteoma: Assessment of the insulating effect of the reactive zone. Int J Hyperth 32(3):221–230

    Article  CAS  Google Scholar 

  30. Rosenthal D, Callstrom MR (2012) Critical review and state of the art in interventional oncology: Benign and metastatic disease involving bone. Radiology 262(3):765–780

    Article  Google Scholar 

  31. Filippiadis DK, Velonakis G, Kostantos C, Kouloulias V, Brountzos E, Kelekis N et al (2017) Computed tomography-guided radiofrequency ablation of intra-articular osteoid osteoma: a single centre’s experience. Int J Hyperth 33(6):670–674

    Article  CAS  Google Scholar 

  32. Mahnken AH, Tacke JA, Wildberger JE, Günther RW (2006) Radiofrequency ablation of osteoid osteoma: Initial results with a bipolar ablation device. J Vasc Interv Radiol 17(9):1465–1470

    Article  Google Scholar 

  33. Kuhaimi TA, Alenezi G, Alawaji A, Alshaikh M, Bauones S (2021) Intra-articular hip joint osteoid osteoma: Challenging diagnosis and percutaneous radiofrequency ablation treatment. Radiol Case Reports [Internet] 16(11):3315–3320. https://doi.org/10.1016/j.radcr.2021.07.072

    Article  Google Scholar 

Download references

Acknowledgements

The researcher (Mostafa Farouk Balbaa) is funded by a full scholarship (mission 2019/2020) from the Ministry of Higher Education of Egypt. The current research work is not funded by the mentioned ministry of Egypt or any other foundation or organization. Authors would like to acknowledge Roberta Aronica for English editing support.

Funding

 This study has not received any funding.

Author information

Author notes

  1. Mostafa Farouk Balbaa and Maria Silvia Spinelli have equally contributed to this work.

Authors and Affiliations

  1. Department of Orthopedic Oncology, ASST Gaetano Pini – CTO, Milan, Italy

    Maria Silvia Spinelli & Primo Andrea Daolio

  2. Department of Radiology, Kafrelsheikh University, Kafr El-Sheikh, Egypt

    Mostafa Farouk Balbaa

  3. Department of Health Sciences, Università Degli Studi Di Milano, Via Festa del Perdono 7, 20122, Milan, Italy

    Mostafa Farouk Balbaa & Gianpaolo Carrafiello

  4. Department of Radiology, ASST Gaetano Pini – CTO, Milan, Italy

    Mauro Battista Gallazzi

  5. Department of Radiology, Alexandria University, Alexandria, Egypt

    Mohamed Emad-Eldin Eid, Hesham Taha Kotb & Mohamed El Shafei

  6. Operative Unit of Radiology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Di Milano, Via Francesco Sforza 35, 20122, Milan, Italy

    Anna Maria Ierardi & Gianpaolo Carrafiello

  7. Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100, L’Aquila, Italy

    Antonio Barile

Authors
  1. Maria Silvia Spinelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mostafa Farouk Balbaa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mauro Battista Gallazzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mohamed Emad-Eldin Eid
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hesham Taha Kotb
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mohamed El Shafei
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Anna Maria Ierardi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Primo Andrea Daolio
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Antonio Barile
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Gianpaolo Carrafiello
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Maria Silvia Spinelli.

Ethics declarations

Conflict of interest

Authors have no conflict of interest.

Ethical standards

This study was designed as a retrospetive study. Research involving human participants. Institutional Review Board approval was obtained.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Spinelli, M.S., Balbaa, M.F., Gallazzi, M.B. et al. Role of percutaneous CT–guided radiofrequency ablation in treatment of intra-articular, in close contact with cartilage and extra-articular osteoid osteomas: comparative analysis and new classification system. Radiol med 127, 1142–1150 (2022). https://doi.org/10.1007/s11547-022-01542-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11547-022-01542-0

Keywords

Search

Navigation