Vascular and Interventional Radiology Unit, Pediatric Hospital Bambino Gesù, Piazza S. Onofrio 4, 00165 Rome, Italy.
Skeletal Radiol. 2011 Dec;40(12):1523-30. doi: 10.1007/s00256-011-1133-3. Epub 2011 Mar 15.
To report on the particular imaging features and high success rate of cold mode radio-frequency thermal ablation (RFTA) as the treatment of choice for intramedullary osteoid osteoma.
The study population consisted of 51 patients (39 males, 12 females; mean age 7.2 years; 11 patients under 6 years of age, including 7 males and 4 females) who underwent RFTA for osteoid osteoma and were retrospectively observed. The affected sites were the tibia (n = 22, 43%), femur (n = 13, 25%), pelvis (n = 5, 10%), anklebone (n = 3, 6%), humerus (n = 2, 4%), sacrum (n = 2, 4%), heel, radium, patella ,and rib (n = 1, 2%), respectively. Three patients had tibial intramedullary osteoid osteoma (14% of the tibial lesions, 6% of all cases). Cold mode RFTA was performed for these three patients to obtain a large ablation area without positioning two probes. The noncooled mode was used to treat cortical and subperiosteal lesions.
Following RFTA, all patients were pain-free and in good clinical condition. In the intramedullary osteoid osteoma group, no recurrences were observed during the 24-month follow-up period, but one patient, who was affected by cortical osteoid osteoma, required two RFTA treatments to heal completely.
Children less than 6 years of age with recurrent nocturnal pain and limb swelling should be investigated for intramedullary osteoid osteoma. Once confirmed, CT-guided RFTA should be the first treatment for intramedullary osteoid osteomas because of the high success rate and reduced invasivity, especially with cold mode RFTA. The outcome is related to the disappearance of pain, and the efficacy may be checked shortly after treatment with MR imaging to evaluate the absence of lesion in the ablation area.
报告冷模式射频热消融（RFTA）作为治疗髓内骨样骨瘤的首选方法的特殊成像特征和高成功率。
研究人群包括 51 名接受 RFTA 治疗骨样骨瘤的患者（39 名男性，12 名女性；平均年龄 7.2 岁；11 名患者年龄小于 6 岁，包括 7 名男性和 4 名女性），并进行回顾性观察。病变部位为胫骨（n=22，43%）、股骨（n=13，25%）、骨盆（n=5，10%）、踝关节（n=3，6%）、肱骨（n=2，4%）、骶骨（n=2，4%）、脚跟、镭、髌骨和肋骨（n=1，2%）。3 名患者胫骨发生髓内骨样骨瘤（胫骨病变的 14%，所有病例的 6%）。对这 3 名患者进行冷模式 RFTA 以获得较大的消融区域，而无需定位两个探头。使用非冷模式治疗皮质和骨膜下病变。
RFTA 后，所有患者均无痛且临床状况良好。在髓内骨样骨瘤组中，在 24 个月的随访期间未观察到复发，但 1 名受皮质骨样骨瘤影响的患者需要两次 RFTA 治疗才能完全愈合。
6 岁以下儿童出现夜间疼痛和肢体肿胀应行髓内骨样骨瘤检查。一旦确诊，CT 引导下 RFTA 应作为髓内骨样骨瘤的首选治疗方法，因为其成功率高，侵袭性低，尤其是冷模式 RFTA。结果与疼痛消失有关，治疗后不久可通过磁共振成像检查评估消融区域是否存在病变来检查疗效。
