Chahal Anurag, Rajalakshmi Prathiba, Khan Shah A, Rastogi Shishir, Srivastava Deep N, Gamanagatti Shivanand
Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India.
Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India.
Indian J Radiol Imaging. 2017 Apr-Jun;27(2):207-215. doi: 10.4103/ijri.IJRI_260_16.
To evaluate the technical and clinical success of radiofrequency ablation of osteoid osteoma and analyze the factors responsible for clinical success. We also tried to investigate the role of follow-up computed tomography (CT) imaging.
This is a prospective study approved by the institute's ethics committee involving 87 patients with appendicular osteoid osteoma. CT-guided radio frequency ablation was performed using a bipolar ablation system. Patients were followed up over 15.4 (4-24) months for pain, and clinical success/failure was determined using established criteria. Patients with clinical failure were taken for repeat ablation. Follow-up CT was obtained at 6 months and correlated with clinical success. Procedural scans were later reviewed for technical success in a blinded manner and correlated with clinical success along with other imaging and patient characteristics.
Mean pre-procedure visual analog scale (VAS) score was 7.0 ± 0.8. Primary success rate after single session was 86.2%(75/87 patients), and overall success rate after one/two sessions was 96.6%(84/87). No major complications were noted. Technical success rate was 89.7%(78/87). All 9 patients who had a suboptimal needle positioning had recurrence where as three patients had recurrence despite technical success. None of the imaging characteristics or history of prior intervention was significantly associated with clinical success. Follow-up CT showed advanced bone healing in 48 lesions, and was confined to the treatment success group. Alternately, minimal/absent bone healing was seen in all (12) patients of primary treatment failure and 27 patients with treatment success.
CT-guided percutaneous radio frequency ablation is a safe and highly effective treatment for osteoid osteomas even in recurrent and residual cases. Technical success is the most important parameter affecting the outcome. Post radio frequency ablation CT findings have a good positive but a poor negative predictive value in prognostication.
评估射频消融骨样骨瘤的技术成功率和临床成功率，并分析影响临床成功的因素。我们还试图研究随访计算机断层扫描（CT）成像的作用。
这是一项经机构伦理委员会批准的前瞻性研究，纳入了87例四肢骨样骨瘤患者。使用双极消融系统进行CT引导下射频消融。对患者进行了15.4（4 - 24）个月的疼痛随访，并根据既定标准确定临床成功/失败。临床失败的患者接受重复消融。在6个月时进行随访CT检查，并与临床成功情况相关联。随后以盲法回顾操作扫描以评估技术成功率，并将其与临床成功以及其他影像和患者特征相关联。
术前平均视觉模拟评分（VAS）为7.0±0.8。单次治疗后的初次成功率为86.2%（75/87例患者），一次/两次治疗后的总体成功率为96.6%（84/87）。未观察到重大并发症。技术成功率为89.7%（78/87）。所有9例针定位欠佳的患者均复发，而3例患者尽管技术成功仍复发。没有任何影像特征或既往干预史与临床成功显著相关。随访CT显示48个病灶有骨愈合进展，且仅限于治疗成功组。相反，在所有初次治疗失败的12例患者和27例治疗成功的患者中均可见最小/无骨愈合。
CT引导下经皮射频消融即使在复发性和残留性病例中也是治疗骨样骨瘤的一种安全且高效的方法。技术成功是影响结果的最重要参数。射频消融后CT表现对预后的阳性预测价值良好，但阴性预测价值较差。
