Comparison of Noninvasive High-Intensity Focused Ultrasound with Radiofrequency Ablation of Osteoid Osteoma

• Published in: The Journal of pediatrics Vol. 190; pp. 222 - 228.e1
• Main Authors: Sharma, Karun V., Yarmolenko, Pavel S., Celik, Haydar, Eranki, Avinash, Partanen, Ari, Smitthimedhin, Anilawan, Kim, Aerang, Oetgen, Matthew, Santos, Domiciano, Patel, Janish, Kim, Peter
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2017
• Subjects: ablation; Adolescent; Bone Neoplasms - diagnostic imaging; Bone Neoplasms - surgery; Catheter Ablation; Child; Child, Preschool; Feasibility Studies; Female; Follow-Up Studies; High-Intensity Focused Ultrasound Ablation - methods; Humans; interventional radiology; Magnetic Resonance Imaging, Interventional; Male; MR-HIFU; MRI; orthopedics; Osteoma, Osteoid - diagnostic imaging; Osteoma, Osteoid - surgery; Pilot Projects; Prospective Studies; radiology; RFA; Treatment Outcome; Young Adult; MR-HIFU; CT; MRI; radiology; NSAID; ablation; orthopedics; VAS; interventional radiology; RFA
• ISSN: 0022-3476; 1097-6833; 1097-6833
• DOI: 10.1016/j.jpeds.2017.06.046

To evaluate clinical feasibility and safety of magnetic resonance imaging-guided high-intensity focused ultrasound (MR-HIFU) treatment of symptomatic osteoid osteoma and to compare clinical response with standard of care treatment. Nine subjects with radiologically confirmed, symptomatic osteoid osteoma were treated with MR-HIFU in an institutional review board–approved clinical trial. Treatment feasibility and safety were assessed. Clinical response was evaluated in terms of analgesic requirement, visual analog scale pain score, and sleep quality. Anesthesia, procedure, and recovery times were recorded. This MR-HIFU group was compared with a historical control group of 9 consecutive patients treated with radiofrequency ablation. Nine subjects (7 male, 2 female; 16 ± 6 years) were treated with MR-HIFU without technical difficulties or any serious adverse events. There was significant decrease in their median pain scores 4 weeks within treatment (6 vs 0, P < .01). Total pain resolution and cessation of analgesics were achieved in 8 of 9 patients after 4 weeks. In the radiofrequency ablation group, 9 patients (8 male, 1 female; 10 ± 6 years) were treated in routine clinical practice. All 9 demonstrated complete pain resolution and cessation of medications by 4 weeks with a significant decrease in median pain scores (9 vs 0, P < .001). One developed a second-degree skin burn, but there were no other adverse events. Procedure times and treatment charges were comparable between the 2 groups. This pilot study shows that MR-HIFU treatment of osteoid osteoma refractory to medical therapy is feasible and can be performed safely in pediatric patients. Clinical response is comparable with standard of care treatment but without any incisions or exposure to ionizing radiation. ClinicalTrials.govNCT02349971