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Osteoid Osteoma: Percutaneous Laser Ablation and Follow-up in 114 Patients¹

¹ From the Department of Radiology, University Hospital of Strasbourg, 1 place de l'hopital, 67091 Strasbourg, France. Received August 11, 2004; revision requested October 27; revision received September 5, 2005; accepted September 23; final version accepted March 20, 2006. Address correspondence to A.G. (e-mail: gangi{at}rad6.u-strasbg.fr).

View larger version (192K): [in this window] [in a new window] [Download PPT slide]   Figure 1a: Images in a 41-year-old woman with severe back and intercostal pain for 3 years. Pain responded to ibuprofen. (a) Bone scintigram (anteroposterior view) shows area of increased activity at level of sixth rib (arrow). (b) CT scan demonstrates lytic lesion in rib and associated reactive pleural thickening. Features were suggestive of osteoid osteoma (arrow). (c) With CT guidance (prone position), 14-gauge needle was placed in center of nidus with posterior approach. A 400-µm fiber was introduced into nidus through cannula. (d) Follow-up CT scan obtained 12 months after ILA demonstrates replacement of lytic lesion with normal bone (arrow) and reduction of pleural thickening.

View larger version (143K): [in this window] [in a new window] [Download PPT slide]   Figure 1b: Images in a 41-year-old woman with severe back and intercostal pain for 3 years. Pain responded to ibuprofen. (a) Bone scintigram (anteroposterior view) shows area of increased activity at level of sixth rib (arrow). (b) CT scan demonstrates lytic lesion in rib and associated reactive pleural thickening. Features were suggestive of osteoid osteoma (arrow). (c) With CT guidance (prone position), 14-gauge needle was placed in center of nidus with posterior approach. A 400-µm fiber was introduced into nidus through cannula. (d) Follow-up CT scan obtained 12 months after ILA demonstrates replacement of lytic lesion with normal bone (arrow) and reduction of pleural thickening.

View larger version (114K): [in this window] [in a new window] [Download PPT slide]   Figure 1c: Images in a 41-year-old woman with severe back and intercostal pain for 3 years. Pain responded to ibuprofen. (a) Bone scintigram (anteroposterior view) shows area of increased activity at level of sixth rib (arrow). (b) CT scan demonstrates lytic lesion in rib and associated reactive pleural thickening. Features were suggestive of osteoid osteoma (arrow). (c) With CT guidance (prone position), 14-gauge needle was placed in center of nidus with posterior approach. A 400-µm fiber was introduced into nidus through cannula. (d) Follow-up CT scan obtained 12 months after ILA demonstrates replacement of lytic lesion with normal bone (arrow) and reduction of pleural thickening.

View larger version (106K): [in this window] [in a new window] [Download PPT slide]   Figure 1d: Images in a 41-year-old woman with severe back and intercostal pain for 3 years. Pain responded to ibuprofen. (a) Bone scintigram (anteroposterior view) shows area of increased activity at level of sixth rib (arrow). (b) CT scan demonstrates lytic lesion in rib and associated reactive pleural thickening. Features were suggestive of osteoid osteoma (arrow). (c) With CT guidance (prone position), 14-gauge needle was placed in center of nidus with posterior approach. A 400-µm fiber was introduced into nidus through cannula. (d) Follow-up CT scan obtained 12 months after ILA demonstrates replacement of lytic lesion with normal bone (arrow) and reduction of pleural thickening.

View larger version (155K): [in this window] [in a new window] [Download PPT slide]   Figure 2a: Images in a 32-year-old man with knee pain for 12 months. Aspirin dramatically relieved pain. (a) Bone scintigram (anteroposterior view) shows area of increased activity in left femoral diaphysis (arrow). (b) Bone window CT scan demonstrates lytic lesion and substantial cortical thickening medially. Imaging findings were typical of osteoid osteoma (arrow). (c) With CT guidance (supine), 14-gauge Bonopty needle was used for cortical perforation and drilling with anterolateral approach. An 18-gauge spinal needle was coaxially inserted into center of nidus. A 400-µm fiber was introduced into nidus through spinal needle. ILA was performed with epidural anesthesia. There was complete pain relief after ILA without complication.

View larger version (119K): [in this window] [in a new window] [Download PPT slide]   Figure 2b: Images in a 32-year-old man with knee pain for 12 months. Aspirin dramatically relieved pain. (a) Bone scintigram (anteroposterior view) shows area of increased activity in left femoral diaphysis (arrow). (b) Bone window CT scan demonstrates lytic lesion and substantial cortical thickening medially. Imaging findings were typical of osteoid osteoma (arrow). (c) With CT guidance (supine), 14-gauge Bonopty needle was used for cortical perforation and drilling with anterolateral approach. An 18-gauge spinal needle was coaxially inserted into center of nidus. A 400-µm fiber was introduced into nidus through spinal needle. ILA was performed with epidural anesthesia. There was complete pain relief after ILA without complication.

View larger version (115K): [in this window] [in a new window] [Download PPT slide]   Figure 2c: Images in a 32-year-old man with knee pain for 12 months. Aspirin dramatically relieved pain. (a) Bone scintigram (anteroposterior view) shows area of increased activity in left femoral diaphysis (arrow). (b) Bone window CT scan demonstrates lytic lesion and substantial cortical thickening medially. Imaging findings were typical of osteoid osteoma (arrow). (c) With CT guidance (supine), 14-gauge Bonopty needle was used for cortical perforation and drilling with anterolateral approach. An 18-gauge spinal needle was coaxially inserted into center of nidus. A 400-µm fiber was introduced into nidus through spinal needle. ILA was performed with epidural anesthesia. There was complete pain relief after ILA without complication.

View larger version (124K): [in this window] [in a new window] [Download PPT slide]   Figure 3a: Images in a 33-year-old man with history of long-standing ankle joint pain and swelling. (a) Sagittal T2-weighted short inversion time inversion-recovery (STIR) MR image (repetition time msec/echo time msec/inversion time msec, 1835/70/160) demonstrates nidus (arrow) in talar neck and adjacent soft-tissue inflammation and edema. (b) Bone window CT scan (coronal view) shows sharply defined lucency and central high-attenuation focus, which is nidus of osteoid osteoma (arrow). (c) Coronal CT scan shows positioning of 18-gauge spinal needle with CT guidance before insertion of optical fiber at ILA. ILA was performed with epidural anesthesia. Patient was released from hospital the day after ILA and had complete pain relief.

View larger version (144K): [in this window] [in a new window] [Download PPT slide]   Figure 3b: Images in a 33-year-old man with history of long-standing ankle joint pain and swelling. (a) Sagittal T2-weighted short inversion time inversion-recovery (STIR) MR image (repetition time msec/echo time msec/inversion time msec, 1835/70/160) demonstrates nidus (arrow) in talar neck and adjacent soft-tissue inflammation and edema. (b) Bone window CT scan (coronal view) shows sharply defined lucency and central high-attenuation focus, which is nidus of osteoid osteoma (arrow). (c) Coronal CT scan shows positioning of 18-gauge spinal needle with CT guidance before insertion of optical fiber at ILA. ILA was performed with epidural anesthesia. Patient was released from hospital the day after ILA and had complete pain relief.

View larger version (114K): [in this window] [in a new window] [Download PPT slide]   Figure 3c: Images in a 33-year-old man with history of long-standing ankle joint pain and swelling. (a) Sagittal T2-weighted short inversion time inversion-recovery (STIR) MR image (repetition time msec/echo time msec/inversion time msec, 1835/70/160) demonstrates nidus (arrow) in talar neck and adjacent soft-tissue inflammation and edema. (b) Bone window CT scan (coronal view) shows sharply defined lucency and central high-attenuation focus, which is nidus of osteoid osteoma (arrow). (c) Coronal CT scan shows positioning of 18-gauge spinal needle with CT guidance before insertion of optical fiber at ILA. ILA was performed with epidural anesthesia. Patient was released from hospital the day after ILA and had complete pain relief.