Journal of Clinical Medicine

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9 pages, 3460 KiB

Open AccessArticle

Weakening or Structural Strengthening? An Evaluation of Bone Density after MRgFUS Ablation for Treatment of Benign Bone Lesions

by Camilla de Cataldo, Federico Bruno, Stefano Necozione, Mariangela Novello, Pierpaolo Palumbo, Luigi Zugaro, Antonio Barile, Carlo Masciocchi and Francesco Arrigoni

J. Clin. Med. 2022, 11(1), 182; https://doi.org/10.3390/jcm11010182 - 29 Dec 2021

Cited by 4 | Viewed by 1535

Abstract

Previous studies suggest that interventional ablative procedures on bone lesions may weaken the bone, especially when performed through the needle approach. Our purpose was to evaluate, through Computed Tomography (CT), the effects of Magnetic Resonance guided Focused Ultrasound Surgery (MRgFUS) ablation on painful [...] Read more.

Previous studies suggest that interventional ablative procedures on bone lesions may weaken the bone, especially when performed through the needle approach. Our purpose was to evaluate, through Computed Tomography (CT), the effects of Magnetic Resonance guided Focused Ultrasound Surgery (MRgFUS) ablation on painful osteoid osteomas and osteoblastomas in terms of bone density and morphological changes. We retrospectively evaluated patients treated at our institution with MRgFUS for superficial, painful osteoid osteoma or osteoblastoma during the last 9 years. Inclusion criteria were procedural and clinical success, as well as the availability of pre- and postprocedural CT examinations. Imaging features assessed were perilesional/nidus density changes and the occurrence of pathological fractures during the follow-up period. Our study population included 31 osteoid osteomas and 5 intra-articular osteoblastomas in 36 treated patients. We found an increased bone density of the lesions when pre and post-treatment CT- values were compared: these differences were statistically significant, and this finding is consistent with significant bone densification at the post-treatment imaging follow-up. No pathological fractures were observed after ablation during the follow-up. MRgFUS can be considered to be the treatment of choice for benign superficial bone lesions, thanks to its minimal invasiveness, excellent effectiveness, and safety. Pathological fractures, reported in literature as a rare event using needle ablation, never occurred in our MRgFUS treatment series. Full article

(This article belongs to the Special Issue Recent Research in Diagnosis and Treatment of Benign Osteocytic Tumours (Osteoma, Osteoid Osteoma, Osteoblastoma))

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10 pages, 1789 KiB

Open AccessArticle

Osteoblastoma: When the Treatment Is Not Minimally Invasive, an Overview

by Carmine Zoccali, Mariangela Novello, Francesco Arrigoni, Alessandra Scotto di Uccio, Dario Attala and Virginia Ferraresi

J. Clin. Med. 2021, 10(20), 4645; https://doi.org/10.3390/jcm10204645 - 10 Oct 2021

Cited by 4 | Viewed by 5042

Abstract

Background: osteoblastoma is a bone-forming tumor accounting for about 1% of all primary bone tumors and 3% of benign bone tumors. The gold-standard treatment is surgical excision; nevertheless, minimally invasive radiological techniques such as thermoablation and, more recently, high intensity focused ultrasound are [...] Read more.

Background: osteoblastoma is a bone-forming tumor accounting for about 1% of all primary bone tumors and 3% of benign bone tumors. The gold-standard treatment is surgical excision; nevertheless, minimally invasive radiological techniques such as thermoablation and, more recently, high intensity focused ultrasound are gaining more importance. The aim of the present paper is to analyze surgical indications based on our experience and on the evidences in the literature. Methods: all patients affected by osteoblastoma who underwent surgical excision in January 2009 and December 2018 were reviewed; eleven patients were enrolled in the study. The epidemiological aspects, size of the disease and site of onset, symptoms, surgery type, indications, and results are reported for every case. Results: all treatments were based on a preoperative diagnosis; pain was constant in all cases. Intralesional surgeries were performed in 9 out of 11 cases; the remaining 2 cases underwent wide resection. No early or late complications occurred after the surgical procedure. The indications for surgery were lesions very close to nerves or joints, unclear diagnosis, risk of fracture, lesion too large for radiofrequency thermoablation, or failure of minimally invasive treatments. At a medium follow-up of 88 months, no local recurrences were verified. Conclusions: osteoblastoma is a rare tumor with difficult diagnosis. Identification is based on symptoms, imaging, and histology. When possible, minimally invasive techniques is preferred for treatment but surgery is still considered the gold standard. Full article

(This article belongs to the Special Issue Recent Research in Diagnosis and Treatment of Benign Osteocytic Tumours (Osteoma, Osteoid Osteoma, Osteoblastoma))

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Review

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8 pages, 1240 KiB

Open AccessReview

Post-Procedural Follow-Up of the Interventional Radiology’s Management of Osteoid Osteomas and Osteoblastomas

by Chiara Acanfora, Enrico Grassi, Giuliana Giacobbe, Marilina Ferrante, Vincenza Granata, Antonio Barile and Salvatore Cappabianca

J. Clin. Med. 2022, 11(7), 1987; https://doi.org/10.3390/jcm11071987 - 2 Apr 2022

Cited by 7 | Viewed by 2649

Abstract

The family of painful osteocytic tumors includes osteoblastomas and osteoid osteomas—these lesions are considered benign, but they could produce a significant painful symptomatology. Usually, people affected are between 20 s and 30 s. When symptomatic, an effective treatment is mandatory for the management [...] Read more.

The family of painful osteocytic tumors includes osteoblastomas and osteoid osteomas—these lesions are considered benign, but they could produce a significant painful symptomatology. Usually, people affected are between 20 s and 30 s. When symptomatic, an effective treatment is mandatory for the management of these lesions to allow for a ful quality of life. The possibilities of treatment range from chirurgical en-block resection (procedure of surgical oncology aiming to remove a tumoral mass in its entirety, completely surrounded by a continuous layer of healthy tissue) to interventional approaches that, nowadays, are considered the most affordable and sustainable in terms of effectiveness, recovery after procedure, and for bone structure sparing. The main techniques used for osteoid osteomas and osteoblastomas are radio frequency ablation (RFA) and magnetic resonance-guided focused ultrasound (MRgFUS): the most important difference between these approaches is the needleless approach of MRgFUS, which further reduces the minimal invasiveness of RFA (and the related consequences) and the absence of exposure to ionizing radiation. Despite their high efficacy, a recurrence of pathology may occur due to a failure in therapy. In light of this, describing the various possibilities of follow up protocols and the imaging aspects of recurrence or incomplete treatment is mandatory. In the scenario given in the literature, many authors have tried to asses an organized follow up protocol of these patients, but many of them did not undergo periodical magnetic resonance (MR) or computerized tomography (CT) because of the lack of symptomatology. However, even if it seems that clinical evolution is central, different papers describe the protocol useful to detect eventual relapse. The aim of our manuscript is to review the various possibilities of follow-up of these patients and to bring together the most salient aspects found during the management of these osteocytic bone lesions. Full article

(This article belongs to the Special Issue Recent Research in Diagnosis and Treatment of Benign Osteocytic Tumours (Osteoma, Osteoid Osteoma, Osteoblastoma))

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12 pages, 508 KiB

Open AccessReview

Interventional Radiology’s Osteoid Osteoma Management: Percutaneous Thermal Ablation

by Giampaolo Bianchi, Luigi Zugaro, Pierpaolo Palumbo, Roberto Candelari, Enrico Paci, Chiara Floridi and Andrea Giovagnoni

J. Clin. Med. 2022, 11(3), 723; https://doi.org/10.3390/jcm11030723 - 29 Jan 2022

Cited by 4 | Viewed by 3303

Abstract

Osteoid osteoma (OO) is one of the most common benign bone tumors with specific clinical and radiological characteristics. Analgesic therapy and surgical treatment have been considered the only therapy for a long time. Recently, safe and effective new therapeutic options have been introduced, [...] Read more.

Osteoid osteoma (OO) is one of the most common benign bone tumors with specific clinical and radiological characteristics. Analgesic therapy and surgical treatment have been considered the only therapy for a long time. Recently, safe and effective new therapeutic options have been introduced, among which percutaneous thermal ablation techniques. This review aims to describe the recent updates in the field of percutaneous thermal ablation techniques in the treatment of OO, assessing the outcomes in terms of efficacy, complications, and recurrence rate. Full article

(This article belongs to the Special Issue Recent Research in Diagnosis and Treatment of Benign Osteocytic Tumours (Osteoma, Osteoid Osteoma, Osteoblastoma))

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8 pages, 6380 KiB

Open AccessReview

Needleless Ablation of Osteoid Osteoma and Osteoblastoma: The Emergent Role of MRgFUS

by Flavia Cobianchi Bellisari, Pierpaolo Palumbo, Carlo Masciocchi, Carmine Zoccali, Antonio Barile and Francesco Arrigoni

J. Clin. Med. 2022, 11(1), 128; https://doi.org/10.3390/jcm11010128 - 27 Dec 2021

Cited by 11 | Viewed by 3037

Abstract

Osteoblastoma (OB) and osteoid osteoma (OO) are benign bone-forming tumors, with nearly identical basic microscopic features. The main difference is dimension (OO has usually a nidus measuring <2 cm in diameter). In addition, OB is biologically more active than OO, with a tendency [...] Read more.

Osteoblastoma (OB) and osteoid osteoma (OO) are benign bone-forming tumors, with nearly identical basic microscopic features. The main difference is dimension (OO has usually a nidus measuring <2 cm in diameter). In addition, OB is biologically more active than OO, with a tendency to grow in size. Historically, treatments have included surgical resection and analgesics, although invasiveness and poor tolerance have led to the current standard of care moving toward interventional radiology, where radiofrequency ablation (RFA) represents the most diffuse technique. Magnetic resonance-guided focused ultrasound surgery (MRgFUS) has recently emerged as another innovative alternative treatment, providing tumor ablation through a needleless and ionizing radiation-free modality. In addition, this technique has the ability to guarantee a very precise and controlled increase in temperature, delivering small amounts of energy that can accurately destroy only the lesion, avoiding healthy surrounding tissues. The present review focuses on MRgFUS as the less invasive, safe, effective, and durable treatment option for the management of osteoid osteoma and osteoblastoma, including a description of technical details, indications and outcomes. Full article

(This article belongs to the Special Issue Recent Research in Diagnosis and Treatment of Benign Osteocytic Tumours (Osteoma, Osteoid Osteoma, Osteoblastoma))

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10 pages, 1229 KiB

Open AccessReview

Management of Osteoblastoma and Giant Osteoid Osteoma with Percutaneous Thermoablation Techniques

by Antonio Izzo, Luigi Zugaro, Eva Fascetti, Federico Bruno, Carmine Zoccali and Francesco Arrigoni

J. Clin. Med. 2021, 10(24), 5717; https://doi.org/10.3390/jcm10245717 - 7 Dec 2021

Cited by 10 | Viewed by 3393

Abstract

Osteoblastoma (OB) is a rare, benign bone tumor, accounting for 1% of all primary bone tumors, which occurs usually in childhood and adolescence. OB is histologically and clinically similar to osteoid osteoma (OO), but it differs in size. It is biologically more aggressive [...] Read more.

Osteoblastoma (OB) is a rare, benign bone tumor, accounting for 1% of all primary bone tumors, which occurs usually in childhood and adolescence. OB is histologically and clinically similar to osteoid osteoma (OO), but it differs in size. It is biologically more aggressive and can infiltrate extraskeletal tissues. Therapy is required because of severe bone pain worsening at night. Moreover, non-steroid anti-inflammatory drugs (NSAIDs) are not a reasonable long-term treatment option in young patients. Surgical excision, considered the gold standard in the past, is no longer attractive today due to its invasiveness and the difficulty in performing a complete resection. The treatment of choice is currently represented by percutaneous thermoablation techniques. Among these, Radiofrequency ablation (RFA) is considered the gold standard treatment, even when the lesions are located in the spine. RFA is a widely available technique that has shown high efficacy and low complication rates in many studies. Other percutaneous thermoablation techniques have been used for the treatment of OB, including Cryoablation (CA) and laser-ablation (LA) with high success rates and low complications. Nevertheless, their role is limited, and further studies are necessary. Full article

(This article belongs to the Special Issue Recent Research in Diagnosis and Treatment of Benign Osteocytic Tumours (Osteoma, Osteoid Osteoma, Osteoblastoma))

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16 pages, 2781 KiB

Open AccessReview

Craniofacial Osteomas: From Diagnosis to Therapy

by Achille Tarsitano, Francesco Ricotta, Paolo Spinnato, Anna Maria Chiesa, Maddalena Di Carlo, Anna Parmeggiani, Marco Miceli and Giancarlo Facchini

J. Clin. Med. 2021, 10(23), 5584; https://doi.org/10.3390/jcm10235584 - 27 Nov 2021

Cited by 20 | Viewed by 11322

Abstract

An osteoma is a benign bone lesion with no clear pathogenesis, almost exclusive to the craniofacial area. Osteomas show very slow continuous growth, even in adulthood, unlike other bony lesions. Since these lesions are frequently asymptomatic, the diagnosis is usually made by plain [...] Read more.

An osteoma is a benign bone lesion with no clear pathogenesis, almost exclusive to the craniofacial area. Osteomas show very slow continuous growth, even in adulthood, unlike other bony lesions. Since these lesions are frequently asymptomatic, the diagnosis is usually made by plain radiography or by a computed tomography (CT) scan performed for other reasons. Rarely, the extensive growth could determine aesthetic or functional problems that vary according to different locations. Radiographically, osteomas appear as radiopaque lesions similar to bone cortex, and may determine bone expansion. Cone beam CT is the optimal imaging modality for assessing the relationship between osteomas and adjacent structures, and for surgical planning. The differential diagnosis includes several inflammatory and tumoral pathologies, but the typical craniofacial location may aid in the diagnosis. Due to the benign nature of osteomas, surgical treatment is limited to symptomatic lesions. Radical surgical resection is the gold standard therapy; it is based on a minimally invasive surgical approach with the aim of achieving an optimal cosmetic result. Reconstructive surgery for an osteoma is quite infrequent and reserved for patients with large central osteomas, such as big mandibular or maxillary lesions. In this regard, computer-assisted surgery guarantees better outcomes, providing the possibility of preoperative simulation of demolitive and reconstructive surgery. Full article

(This article belongs to the Special Issue Recent Research in Diagnosis and Treatment of Benign Osteocytic Tumours (Osteoma, Osteoid Osteoma, Osteoblastoma))

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13 pages, 8246 KiB

Open AccessReview

Imaging Review of Pediatric Benign Osteocytic Tumors and Latest Updates on Management

by Jignesh Shah, Darshan Gandhi, Ankita Chauhan and Saurabh Gupta

J. Clin. Med. 2021, 10(13), 2823; https://doi.org/10.3390/jcm10132823 - 26 Jun 2021

Cited by 8 | Viewed by 7344

Abstract

Pediatric benign osteocytic tumors include osteoma, enostosis, osteoid osteoma, and osteoblastoma. In pediatric populations, benign bone tumors are more common than malignancies. Benign osteocytic tumors may have a unique clinical presentation that helps narrow the differential diagnosis. A systemic imaging approach should be [...] Read more.

Pediatric benign osteocytic tumors include osteoma, enostosis, osteoid osteoma, and osteoblastoma. In pediatric populations, benign bone tumors are more common than malignancies. Benign osteocytic tumors may have a unique clinical presentation that helps narrow the differential diagnosis. A systemic imaging approach should be utilized to reach the diagnosis and guide clinicians in management. Radiographs are the most prevalent and cost-effective imaging modality. Cross-sectional imaging can be utilized for tissue characterization and for evaluation of lesions involving complex anatomical areas such as the pelvis and spine. Computed Tomography (CT) is the modality of choice for diagnosis of osteoid osteoma. CT scan can also be utilized to guide radiofrequency ablation, which has been found to be highly effective in treating osteoid osteoma and osteoblastoma. Enostosis is a no-touch lesion. Osteoma is commonly located in the paranasal sinuses. Osteoma needs an excision if it causes complications due to a mass effect. Full article

(This article belongs to the Special Issue Recent Research in Diagnosis and Treatment of Benign Osteocytic Tumours (Osteoma, Osteoid Osteoma, Osteoblastoma))

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