Rosenbaum Dov, Patel Vandan, Sankar Wudbhav N, Arkadre Alexandre, Nguyen Jie C
Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA.
Pediatr Radiol. 2025 Mar;55(3):520-529. doi: 10.1007/s00247-024-06149-3. Epub 2025 Jan 20.
Osteoid osteomas are most commonly found in the femur and preferentially affect the pediatric population. Magnetic resonance imaging (MRI) findings of femoral osteoid osteomas are not well described.
To systematically characterize pretreatment MRI findings of clinically confirmed femur osteoid osteomas in children and determine location-dependent differences.
The current study included children (< 18 years) with clinically confirmed femoral osteoid osteomas, who underwent pretreatment MRI in the last 14 years (2009-2023). Two radiologists retrospectively reviewed all examinations and recorded skeletal maturity, lesion size, epicenter, perilesional dark rim, and concomitant subjacent findings. Chi-squared, Mann-Whitney U, and Kruskal-Wallis tests were used to compare MRI findings between femoral neck and shaft lesions and for subgroup analyses among lesions along the proximal, mid, and distal femoral neck.
Our study group included 35 pediatric patients (19 boys, 16 girls, mean age 10.1 ± 3.7; range 4.0-17.3 years) with 23 femoral neck and 12 femoral shaft lesions. Radiologists' agreement on MRI findings ranged between 49-100%. Neck lesions were more common among older patients while shaft lesions were more common among younger patients (11.6 ± 3.2 vs. 7.0 ± 2.8 years, P < 0.01). Complete perilesional dark rim sign was more common in the femoral shaft than in the femoral neck (92%, 11/12 vs. 17%, 4/23, P < 0.01). Within the femoral neck, a complete dark rim was more commonly observed with lesions in the distal third compared to mid and proximal third (50% vs. 0%, 0%, P = 0.04). Concomitant findings were common, but only effusion-synovitis was significantly more common in femoral neck lesions than in shaft lesions (65% vs. 0%, P < 0.01). And within the neck, effusion-synovitis was more common with proximal and mid than distal neck lesions (100%, 85% vs. 25%, P = 0.01).
Differential MRI findings were observed not only between osteoid osteomas in the femoral neck and shaft, but also between lesions located within the proximal and distal neck. Patterns of findings follow the known anatomic boundary of the femoral neck/shaft and these findings can help improve pretreatment diagnostic accuracy.
骨样骨瘤最常见于股骨，且优先影响儿童群体。关于股骨骨样骨瘤的磁共振成像（MRI）表现描述并不充分。
系统描述临床确诊的儿童股骨骨样骨瘤的治疗前MRI表现，并确定位置依赖性差异。
本研究纳入过去14年（2009 - 2023年）接受治疗前MRI检查的临床确诊股骨骨样骨瘤患儿（<18岁）。两名放射科医生回顾性审查所有检查，并记录骨骼成熟度、病变大小、中心、病灶周围暗环以及伴随的下方表现。采用卡方检验、曼 - 惠特尼U检验和克鲁斯卡尔 - 沃利斯检验比较股骨颈和骨干病变的MRI表现，并对股骨颈近端、中段和远端病变进行亚组分析。
我们的研究组包括35例儿科患者（19例男孩，16例女孩，平均年龄10.1±3.7岁；范围4.0 - 17.3岁），其中股骨颈病变23例，股骨干病变12例。放射科医生对MRI表现的一致性在49% - 100%之间。颈部病变在年龄较大的患者中更常见，而骨干病变在年龄较小的患者中更常见（11.6±3.2岁 vs. 7.0±2.8岁，P < 0.01）。病灶周围完整暗环征在股骨干比在股骨颈更常见（92%，11/12 vs. 17%，4/23，P < 0.01）。在股骨颈内，与中段和近端相比，远端三分之一的病变更常观察到完整暗环（50% vs. 0%，0%，P = 0.04）。伴随表现常见，但仅积液性滑膜炎在股骨颈病变中比在骨干病变中更显著常见（65% vs. 0%，P < 0.01）。在颈部，近端和中段病变的积液性滑膜炎比远端病变更常见（100%，85% vs. 25%，P = 0.01）。
不仅在股骨颈和骨干的骨样骨瘤之间观察到MRI表现的差异，而且在近端和远端颈部的病变之间也存在差异。这些表现模式遵循股骨颈/骨干已知的解剖边界，这些发现有助于提高治疗前诊断准确性。
