Tips and tricks of Radiofrequency ablation of spinal osteoid osteoma and osteoblastoma

This poster was previously presented in German at the Deutscher Röntgenkongress 2012 (Hamburg)

Congress:

ECR 2013

Poster Number:

C-2182

Type:

Educational Exhibit

Keywords:

Interventional non-vascular, Musculoskeletal spine, CT, MR, Ablation procedures, Education and training

Authors:

C. Rehnitz, S. Sprengel, M. Weber; Heidelberg/DE

DOI:

10.1594/ecr2013/C-2182

DOI-Link:

https://dx.doi.org/10.1594/ecr2013/C-2182

Fig. 1: Osteoid osteoma within the lamina of TH 12 with intact cortial bone

Fig. 2: The sagittal MPR reconstruction demonstrates the oval shape of the nidus.

Fig. 3: Sagittal reconstruction. Access path from inferior oblique to adjust ablation...

Fig. 4: Exact visualization: 2.1 cm osteoblastoma in Th 4

Learning objectives

(1)Practical guidance to manage RFA in spinal osteoid osteoma (OO) and osteoblastoma (OB) (2) Advanced technical tips and tricks in complex cases (thermal protection, 3D planning, multiple needle positions. (3) To learn about typical pre- und post RFA MR imaging.

Background

. OO account for 13.5% of all benign bone tumors. 10% of OO are located in the spine. OB: similar histology, >1.5 cm. 4x less frequent Clinical presentation: Pain worsening at night responding to NSAID. Spinally often non-specific , e.g. painful scoliosis. Therapy: OO peripheral bones: CT-guided radiofrequency ablation (RFA). Success rates today >90% (Ref 1) spinal: often surgery due to safety concerns (spinal nerve, central cord). With increasing experience: CT-RFA increasingly used. Largest spinal patient collective: 24 OO (Ref 2). success rate 23/24. Personal...

Imaging findings OR Procedure details

Standard technique: Figs 1-3 • Spinal CT-guided RFA analog to RFA in peripheral OO without specific protection techniques • Prerequisites: ØIntact cortical bone as an isolator between OO and central cord/spinal nerve. ØDistance OO/critical nerval structure > 1 cm (Ref 4) • RFA principle: The RF-elektrode has an active tip=> conducts a current=> local ion movement=> friction heat=> ablation (coagulation necrosis) •: Step by step: optimal access planing (using 3D multiplanar reconstructions). Bone puncture (e.g.. Bonopty® , AprioMed, Sweden). Placement of the active tip (we...

Conclusion

CT-guided RFA of spinal OO is possible in most localisations. As it is minimal-invasive, safe and effective it should be the method of choice in most spinal OO. Moreover, RFA is effective in the treatment of osteoblastoma too and should therefore be regarded as a minimal-invasive therapy option, although long term experience in large patient collective is lacking. The knowledge of the typical imaging patterns enhances the primary diagnosis and helps to evaluate the therapy success.

References

1 Omlor G et al. CT-gesteuerte perkutane Radiofrequenzablation des Osteoid-Osteoms: ... Fortschr Röntgenstr 2012; 184(4) 2 Vanderschueren G et al. Radiofrequency ablation of spinal osteoid osteoma: ... Spine 2009 Vol. 34(09) 3 Rehnitz C et al. CT-guided radiofrequency ablation of osteoid osteoma and osteoblastoma … EJR 2012, Nov;81(11):3426-34 4 Bitsch RG et al. Osteoid osteoma in an ex vivo animal model…Radiology 2006; 238: 107-112 5 Rimondi E. et al. Radiofrequency ablation for non-spinal osteoid osteomas... Radiology 2012; 22(1):181-8 6 Pinto et al. Technical considerations in...