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Imaging of Osteoid Osteoma with Dynamic Gadolinium-enhanced MR Imaging¹

¹ From the Departments of Radiology (P.T.L., F.S.C., C.C.R., C.J.S.) and Orthopedic Surgery (C.P.B.), Mayo Clinic Scottsdale, 13400 E Shea Blvd, Scottsdale, AZ 85259; and Radiology Medical Group of Napa, Calif (C.J.S.). From the 2001 RSNA scientific assembly. Received February 18, 2002; revision requested April 22; final revision received October 14; accepted November 6. Address correspondence to P.T.L. (e-mail: liu.patrick@mayo.edu).

View larger version (120K): [in a new window]   Figure 1a. Patient 6. A 12-year-old boy with intermittent right hip pain who previously underwent biopsy and curettage of proximal femoral metaphysis marrow lesion found at MR imaging performed elsewhere (not shown). His pain persisted despite the surgery. Transverse (a) T1-weighted and (b) T2-weighted fat-suppressed MR images show a lateral bone graft (arrowhead), diffusely decreased T1-weighted signal intensity and increased T2-weighted signal intensity in the medullary space, and a medial 7-mm cortical defect (arrow). (c) Transverse CT image shows that the medial cortical lesion is hypoattenuating compared with surrounding bone (arrow), which suggests a differential diagnosis of surgical defect, Brodie abscess, or osteoid osteoma. Cortical bone graft (arrowhead) is visible lateral to the femur. (d) Transverse dynamic gadolinium-enhanced MR images obtained (clockwise from upper left) before injection of contrast material and 30, 90, and 150 seconds after injection of contrast material show rapid enhancement of the focal lesion (arrow) in the medial cortex, followed quickly by partial washout. (e) Delayed coronal T1-weighted fast spoiled gradient-echo image obtained 5 minutes after injection of contrast material with the same parameters as dynamic gadolinium-enhanced MR imaging. Image shows that the osteoid osteoma (arrow) and adjacent marrow have similar signal intensity. Biopsy revealed osteoid osteoma. The patient’s pain was relieved with CT-guided radio-frequency ablation. Dynamic gadolinium-enhanced MR imaging was scored as better than nonenhanced MR imaging and CT.

View larger version (109K): [in a new window]   Figure 1b. Patient 6. A 12-year-old boy with intermittent right hip pain who previously underwent biopsy and curettage of proximal femoral metaphysis marrow lesion found at MR imaging performed elsewhere (not shown). His pain persisted despite the surgery. Transverse (a) T1-weighted and (b) T2-weighted fat-suppressed MR images show a lateral bone graft (arrowhead), diffusely decreased T1-weighted signal intensity and increased T2-weighted signal intensity in the medullary space, and a medial 7-mm cortical defect (arrow). (c) Transverse CT image shows that the medial cortical lesion is hypoattenuating compared with surrounding bone (arrow), which suggests a differential diagnosis of surgical defect, Brodie abscess, or osteoid osteoma. Cortical bone graft (arrowhead) is visible lateral to the femur. (d) Transverse dynamic gadolinium-enhanced MR images obtained (clockwise from upper left) before injection of contrast material and 30, 90, and 150 seconds after injection of contrast material show rapid enhancement of the focal lesion (arrow) in the medial cortex, followed quickly by partial washout. (e) Delayed coronal T1-weighted fast spoiled gradient-echo image obtained 5 minutes after injection of contrast material with the same parameters as dynamic gadolinium-enhanced MR imaging. Image shows that the osteoid osteoma (arrow) and adjacent marrow have similar signal intensity. Biopsy revealed osteoid osteoma. The patient’s pain was relieved with CT-guided radio-frequency ablation. Dynamic gadolinium-enhanced MR imaging was scored as better than nonenhanced MR imaging and CT.

View larger version (96K): [in a new window]   Figure 1c. Patient 6. A 12-year-old boy with intermittent right hip pain who previously underwent biopsy and curettage of proximal femoral metaphysis marrow lesion found at MR imaging performed elsewhere (not shown). His pain persisted despite the surgery. Transverse (a) T1-weighted and (b) T2-weighted fat-suppressed MR images show a lateral bone graft (arrowhead), diffusely decreased T1-weighted signal intensity and increased T2-weighted signal intensity in the medullary space, and a medial 7-mm cortical defect (arrow). (c) Transverse CT image shows that the medial cortical lesion is hypoattenuating compared with surrounding bone (arrow), which suggests a differential diagnosis of surgical defect, Brodie abscess, or osteoid osteoma. Cortical bone graft (arrowhead) is visible lateral to the femur. (d) Transverse dynamic gadolinium-enhanced MR images obtained (clockwise from upper left) before injection of contrast material and 30, 90, and 150 seconds after injection of contrast material show rapid enhancement of the focal lesion (arrow) in the medial cortex, followed quickly by partial washout. (e) Delayed coronal T1-weighted fast spoiled gradient-echo image obtained 5 minutes after injection of contrast material with the same parameters as dynamic gadolinium-enhanced MR imaging. Image shows that the osteoid osteoma (arrow) and adjacent marrow have similar signal intensity. Biopsy revealed osteoid osteoma. The patient’s pain was relieved with CT-guided radio-frequency ablation. Dynamic gadolinium-enhanced MR imaging was scored as better than nonenhanced MR imaging and CT.

View larger version (158K): [in a new window]   Figure 1d. Patient 6. A 12-year-old boy with intermittent right hip pain who previously underwent biopsy and curettage of proximal femoral metaphysis marrow lesion found at MR imaging performed elsewhere (not shown). His pain persisted despite the surgery. Transverse (a) T1-weighted and (b) T2-weighted fat-suppressed MR images show a lateral bone graft (arrowhead), diffusely decreased T1-weighted signal intensity and increased T2-weighted signal intensity in the medullary space, and a medial 7-mm cortical defect (arrow). (c) Transverse CT image shows that the medial cortical lesion is hypoattenuating compared with surrounding bone (arrow), which suggests a differential diagnosis of surgical defect, Brodie abscess, or osteoid osteoma. Cortical bone graft (arrowhead) is visible lateral to the femur. (d) Transverse dynamic gadolinium-enhanced MR images obtained (clockwise from upper left) before injection of contrast material and 30, 90, and 150 seconds after injection of contrast material show rapid enhancement of the focal lesion (arrow) in the medial cortex, followed quickly by partial washout. (e) Delayed coronal T1-weighted fast spoiled gradient-echo image obtained 5 minutes after injection of contrast material with the same parameters as dynamic gadolinium-enhanced MR imaging. Image shows that the osteoid osteoma (arrow) and adjacent marrow have similar signal intensity. Biopsy revealed osteoid osteoma. The patient’s pain was relieved with CT-guided radio-frequency ablation. Dynamic gadolinium-enhanced MR imaging was scored as better than nonenhanced MR imaging and CT.

View larger version (132K): [in a new window]   Figure 1e. Patient 6. A 12-year-old boy with intermittent right hip pain who previously underwent biopsy and curettage of proximal femoral metaphysis marrow lesion found at MR imaging performed elsewhere (not shown). His pain persisted despite the surgery. Transverse (a) T1-weighted and (b) T2-weighted fat-suppressed MR images show a lateral bone graft (arrowhead), diffusely decreased T1-weighted signal intensity and increased T2-weighted signal intensity in the medullary space, and a medial 7-mm cortical defect (arrow). (c) Transverse CT image shows that the medial cortical lesion is hypoattenuating compared with surrounding bone (arrow), which suggests a differential diagnosis of surgical defect, Brodie abscess, or osteoid osteoma. Cortical bone graft (arrowhead) is visible lateral to the femur. (d) Transverse dynamic gadolinium-enhanced MR images obtained (clockwise from upper left) before injection of contrast material and 30, 90, and 150 seconds after injection of contrast material show rapid enhancement of the focal lesion (arrow) in the medial cortex, followed quickly by partial washout. (e) Delayed coronal T1-weighted fast spoiled gradient-echo image obtained 5 minutes after injection of contrast material with the same parameters as dynamic gadolinium-enhanced MR imaging. Image shows that the osteoid osteoma (arrow) and adjacent marrow have similar signal intensity. Biopsy revealed osteoid osteoma. The patient’s pain was relieved with CT-guided radio-frequency ablation. Dynamic gadolinium-enhanced MR imaging was scored as better than nonenhanced MR imaging and CT.

View larger version (132K): [in a new window]   Figure 2a. Patient 4. A 29-year-old woman with a 4-year history of atypical symptoms of intermittently occurring severe hip pain that became worse in daytime. She previously underwent two nonenhanced MR imaging examinations performed elsewhere (not shown) for hip pain, and the results were interpreted as normal. Transverse (a) T1-weighted and (b) T2-weighted fat-saturated MR images demonstrate a nonspecific 5-mm well-defined round lesion (arrow) in the cancellous bone of the left supraacetabular ilium with no surrounding sclerosis or marrow edema. (c) Transverse 2-mm-thick CT scan shows nonspecific appearance of the lesion (arrow) with no surrounding medullary or cortical sclerosis. (d) Transverse dynamic gadolinium-enhanced MR images obtained (clockwise from upper left) before injection of contrast material and 30, 90, and 150 seconds after injection of contrast material show rapid enhancement of the focal lesion (arrow), followed quickly by partial washout. Biopsy revealed osteoid osteoma. The patient’s pain was relieved with CT-guided radio-frequency ablation. Dynamic gadolinium-enhanced MR imaging was scored as better than nonenhanced MR imaging and equal to CT.

View larger version (113K): [in a new window]   Figure 2b. Patient 4. A 29-year-old woman with a 4-year history of atypical symptoms of intermittently occurring severe hip pain that became worse in daytime. She previously underwent two nonenhanced MR imaging examinations performed elsewhere (not shown) for hip pain, and the results were interpreted as normal. Transverse (a) T1-weighted and (b) T2-weighted fat-saturated MR images demonstrate a nonspecific 5-mm well-defined round lesion (arrow) in the cancellous bone of the left supraacetabular ilium with no surrounding sclerosis or marrow edema. (c) Transverse 2-mm-thick CT scan shows nonspecific appearance of the lesion (arrow) with no surrounding medullary or cortical sclerosis. (d) Transverse dynamic gadolinium-enhanced MR images obtained (clockwise from upper left) before injection of contrast material and 30, 90, and 150 seconds after injection of contrast material show rapid enhancement of the focal lesion (arrow), followed quickly by partial washout. Biopsy revealed osteoid osteoma. The patient’s pain was relieved with CT-guided radio-frequency ablation. Dynamic gadolinium-enhanced MR imaging was scored as better than nonenhanced MR imaging and equal to CT.

View larger version (123K): [in a new window]   Figure 2c. Patient 4. A 29-year-old woman with a 4-year history of atypical symptoms of intermittently occurring severe hip pain that became worse in daytime. She previously underwent two nonenhanced MR imaging examinations performed elsewhere (not shown) for hip pain, and the results were interpreted as normal. Transverse (a) T1-weighted and (b) T2-weighted fat-saturated MR images demonstrate a nonspecific 5-mm well-defined round lesion (arrow) in the cancellous bone of the left supraacetabular ilium with no surrounding sclerosis or marrow edema. (c) Transverse 2-mm-thick CT scan shows nonspecific appearance of the lesion (arrow) with no surrounding medullary or cortical sclerosis. (d) Transverse dynamic gadolinium-enhanced MR images obtained (clockwise from upper left) before injection of contrast material and 30, 90, and 150 seconds after injection of contrast material show rapid enhancement of the focal lesion (arrow), followed quickly by partial washout. Biopsy revealed osteoid osteoma. The patient’s pain was relieved with CT-guided radio-frequency ablation. Dynamic gadolinium-enhanced MR imaging was scored as better than nonenhanced MR imaging and equal to CT.

View larger version (147K): [in a new window]   Figure 2d. Patient 4. A 29-year-old woman with a 4-year history of atypical symptoms of intermittently occurring severe hip pain that became worse in daytime. She previously underwent two nonenhanced MR imaging examinations performed elsewhere (not shown) for hip pain, and the results were interpreted as normal. Transverse (a) T1-weighted and (b) T2-weighted fat-saturated MR images demonstrate a nonspecific 5-mm well-defined round lesion (arrow) in the cancellous bone of the left supraacetabular ilium with no surrounding sclerosis or marrow edema. (c) Transverse 2-mm-thick CT scan shows nonspecific appearance of the lesion (arrow) with no surrounding medullary or cortical sclerosis. (d) Transverse dynamic gadolinium-enhanced MR images obtained (clockwise from upper left) before injection of contrast material and 30, 90, and 150 seconds after injection of contrast material show rapid enhancement of the focal lesion (arrow), followed quickly by partial washout. Biopsy revealed osteoid osteoma. The patient’s pain was relieved with CT-guided radio-frequency ablation. Dynamic gadolinium-enhanced MR imaging was scored as better than nonenhanced MR imaging and equal to CT.

View larger version (146K): [in a new window]   Figure 3a. Patient 5. A 14-year-old girl with a 5-month history of intermittent knee pain throughout the day and night. Initial radiographs and nonenhanced MR images obtained elsewhere (not shown) were interpreted as normal. Transverse (a) T1-weighted and (b) T2-weighted fat-suppressed MR images of the distal femoral metaphysis show a 1-cm anterior subcortical lobulated lesion (thick arrow) surrounded by a poorly defined area of cortical and subcortical edema and periosteal reaction (thin arrows). (c) Transverse CT image shows a 4-mm-diameter, round, hypoattenuating, subcortical lesion (thick arrow) with a calcified nidus and surrounding medullary sclerosis. Overlying cortical disruption and periosteal reaction (thin arrows) indicate possible Brodie abscess or osteoid osteoma. (d) Transverse dynamic gadolinium-enhanced MR images obtained (clockwise from upper left) before injection of contrast material and 30, 90, and 150 seconds after injection of contrast material show rapid enhancement of the focal lesion (arrow), followed quickly by partial washout. Early enhancement is localized to the nidus, and there is delayed enhancement of the surrounding marrow and periosteal edema. Biopsy of the enhancing lesion was performed and revealed osteoid osteoma. The patient’s pain was relieved with CT-guided radio-frequency ablation. Dynamic gadolinium-enhanced MR imaging was scored as better than nonenhanced MR imaging and equal to CT.

View larger version (142K): [in a new window]   Figure 3b. Patient 5. A 14-year-old girl with a 5-month history of intermittent knee pain throughout the day and night. Initial radiographs and nonenhanced MR images obtained elsewhere (not shown) were interpreted as normal. Transverse (a) T1-weighted and (b) T2-weighted fat-suppressed MR images of the distal femoral metaphysis show a 1-cm anterior subcortical lobulated lesion (thick arrow) surrounded by a poorly defined area of cortical and subcortical edema and periosteal reaction (thin arrows). (c) Transverse CT image shows a 4-mm-diameter, round, hypoattenuating, subcortical lesion (thick arrow) with a calcified nidus and surrounding medullary sclerosis. Overlying cortical disruption and periosteal reaction (thin arrows) indicate possible Brodie abscess or osteoid osteoma. (d) Transverse dynamic gadolinium-enhanced MR images obtained (clockwise from upper left) before injection of contrast material and 30, 90, and 150 seconds after injection of contrast material show rapid enhancement of the focal lesion (arrow), followed quickly by partial washout. Early enhancement is localized to the nidus, and there is delayed enhancement of the surrounding marrow and periosteal edema. Biopsy of the enhancing lesion was performed and revealed osteoid osteoma. The patient’s pain was relieved with CT-guided radio-frequency ablation. Dynamic gadolinium-enhanced MR imaging was scored as better than nonenhanced MR imaging and equal to CT.

View larger version (154K): [in a new window]   Figure 3c. Patient 5. A 14-year-old girl with a 5-month history of intermittent knee pain throughout the day and night. Initial radiographs and nonenhanced MR images obtained elsewhere (not shown) were interpreted as normal. Transverse (a) T1-weighted and (b) T2-weighted fat-suppressed MR images of the distal femoral metaphysis show a 1-cm anterior subcortical lobulated lesion (thick arrow) surrounded by a poorly defined area of cortical and subcortical edema and periosteal reaction (thin arrows). (c) Transverse CT image shows a 4-mm-diameter, round, hypoattenuating, subcortical lesion (thick arrow) with a calcified nidus and surrounding medullary sclerosis. Overlying cortical disruption and periosteal reaction (thin arrows) indicate possible Brodie abscess or osteoid osteoma. (d) Transverse dynamic gadolinium-enhanced MR images obtained (clockwise from upper left) before injection of contrast material and 30, 90, and 150 seconds after injection of contrast material show rapid enhancement of the focal lesion (arrow), followed quickly by partial washout. Early enhancement is localized to the nidus, and there is delayed enhancement of the surrounding marrow and periosteal edema. Biopsy of the enhancing lesion was performed and revealed osteoid osteoma. The patient’s pain was relieved with CT-guided radio-frequency ablation. Dynamic gadolinium-enhanced MR imaging was scored as better than nonenhanced MR imaging and equal to CT.

View larger version (138K): [in a new window]   Figure 3d. Patient 5. A 14-year-old girl with a 5-month history of intermittent knee pain throughout the day and night. Initial radiographs and nonenhanced MR images obtained elsewhere (not shown) were interpreted as normal. Transverse (a) T1-weighted and (b) T2-weighted fat-suppressed MR images of the distal femoral metaphysis show a 1-cm anterior subcortical lobulated lesion (thick arrow) surrounded by a poorly defined area of cortical and subcortical edema and periosteal reaction (thin arrows). (c) Transverse CT image shows a 4-mm-diameter, round, hypoattenuating, subcortical lesion (thick arrow) with a calcified nidus and surrounding medullary sclerosis. Overlying cortical disruption and periosteal reaction (thin arrows) indicate possible Brodie abscess or osteoid osteoma. (d) Transverse dynamic gadolinium-enhanced MR images obtained (clockwise from upper left) before injection of contrast material and 30, 90, and 150 seconds after injection of contrast material show rapid enhancement of the focal lesion (arrow), followed quickly by partial washout. Early enhancement is localized to the nidus, and there is delayed enhancement of the surrounding marrow and periosteal edema. Biopsy of the enhancing lesion was performed and revealed osteoid osteoma. The patient’s pain was relieved with CT-guided radio-frequency ablation. Dynamic gadolinium-enhanced MR imaging was scored as better than nonenhanced MR imaging and equal to CT.

View larger version (44K): [in a new window]   Figure 4. Time-enhancement graph for lesions. Nine of the 11 patients showed peak enhancement at 30 seconds followed by rapid partial washout. Patient 11 showed atypical enhancement peak at 90 seconds, and patient 9 showed progressive enhancement throughout all phases. Numbers in box refer to patient numbers. pre-Gad = before administration of contrast material.

View larger version (48K): [in a new window]   Figure 5. Time-enhancement graph for bone marrow adjacent to the osteoid osteomas. Signal intensity of bone marrow was measured at a distance of 1 cm from the osteoid osteoma nidus. Marrow enhancement generally increased progressively throughout all imaging phases. Numbers in box refer to patient numbers. pre-Gad = before administration of contrast material.

View larger version (42K): [in a new window]   Figure 6. Graphs of lesion-to-marrow enhancement ratio. For most patients, the peak lesion-to-marrow enhancement occurred at 30 seconds and returned nearly to the baseline level by 150 seconds. Numbers in box refer to patient numbers. pre-Gad = before administration of contrast material.