A comparative study assessing the efficacy and safety of radiofrequency ablation versus surgical treatment for osteoid osteoma: retrospective analysis in a single institution

Jasminka Igrec; Maria Anna Smolle; Michael Meszarics; Theresa Marie Godschachner; Jakob Steiner; Mira Feichtinger; Emina Talakic; Rupert Horst Portugaller; Andreas Leithner; Michael Fuchsjäger; Iva Brcic

doi:10.1186/s13244-024-01656-1

A comparative study assessing the efficacy and safety of radiofrequency ablation versus surgical treatment for osteoid osteoma: retrospective analysis in a single institution

Insights Imaging. 2024 Mar 22;15(1):82. doi: 10.1186/s13244-024-01656-1.

Affiliations

¹ Division of General Radiology, Department of Radiology, Medical University of Graz, Graz, Austria.
² Department of Orthopaedics and Traumatology, Medical University of Graz, Graz, Austria.
³ Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria.
⁴ Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria.
⁵ Division of General Radiology, Department of Radiology, Medical University of Graz, Graz, Austria. michael.fuchsjaeger@medunigraz.at.
⁶ Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria. iva.brcic@medunigraz.at.

Abstract

Objective: We aim to evaluate the efficacy of CT-guided percutaneous radiofrequency ablation (RFA) and surgical treatment in osteoid osteoma (OO) treated at the Medical University of Graz.

Materials and methods: In a single-institution study, we analysed data from January 2005 to January 2021 of patients with histological/radiological diagnosis of OO. CT and MRI scans were reviewed for typical findings. Means (with SD) and medians (with IQR) were reported for normally and non-normally distributed variables. Differences between groups were assessed using chi-squared tests and t-tests.

Results: One hundred nineteen patients (mean age: 21.6 ± 10.9 years; 63.9% males) with confirmed OO were retrospectively evaluated. 73 and 43 patients underwent RFA and surgery, respectively. In three cases, RFA combined with surgery was performed. Pre-intervention, 103 patients (88.8%) had undergone CT, and 101 had an MRI (87.1%). The nidus was confirmed in 82.5% of cases with CTs (85/103) and 63.4% with MRIs (64/101). The majority of nidi were located cortically (n = 96; 82.8%), most frequently in the femur (38 patients, 33.3%) with a median size of 8.0 mm (IQR: 5.0-12.0 mm). Median symptom duration before treatment was 6.0 (IQR: 4.0-13.0) months. The complication rate was 12.1% (14/116; 15.1% RFA vs. 7.0% surgery; p = 0.196). In total, 11.2% of patients had persistent symptoms after one week with clinical success rates of RFA and surgery, 86.3% and 90.7% (p = 0.647), respectively.

Conclusion: Compared to surgical treatment, CT-guided percutaneous RFA is a safe, minimally invasive, reliable, and efficient treatment option for OO.

Critical relevance statement: This article critically assesses the diagnosis and treatment of osteoid osteoma, emphasising accurate imaging, and detailing a non-invasive option for effective management.

Key points: • This study analyses 116 cases of OO at one institution, focusing on symptom persistence, recurrence in short-term follow-up, and complications in two study groups. • Surgery showed higher, though not statistically significant, success despite comparable symptom persistence; CT displayed typical OO features more than MRI, regardless of the intramedullary, cortical and subperiosteal location as well as the site of the affected bone. • CT-guided RFA is an effective therapeutic alternative for OO compared to surgical intervention. In case of atypical OO appearance, RFA is not the first-line treatment.

Keywords: CT; MRI; Osteoid osteoma; Radiofrequency ablation.