Çocuk ve Adölesanlarda Osteoid Osteomaların Görüntüleme Bulguları, Tanıda BT ve MRG'nin Yeri: Tek Merkez Deneyimi

Year 2022, , 272 - 279, 31.08.2022

Zehra Filiz Karaman

https://doi.org/10.24938/kutfd.1036388

Abstract

Amaç: Pediatrik yaş grubundaki osteoid osteomaları analize ederek, olguların demografik özellikleri, lezyonların radyolojik bulgularını tespit etmek, Bilgisayarlı Tomografi ve Manyetik Rezonans Görüntüleme (MRG)’nin tanıdaki yerini belirlemektir.

Gereç ve Yöntemler: Kurumsal hasta bilgi sistemi ve görüntüleme arşiv sistemi kullanılarak 44 çocuk ve adolesanda tespit edilen osteoid osteoma lezyonu retrospektif olarak analiz edilmiştir. Yaş, cinsiyet dağılımı, tercih edilen tedavi seçeneği, tanıda tercih edilen kesitsel görüntüleme modalitesi (MRG, BT), tümör yeri, tümörün kemikteki lokalizasyonu, kalsifiye nidus varlığı, perilezyonal reaktif skleroz, kortikal kalınlaşma, perilezyonal kemik iliği ödemi ve eklem effüzyonu varlığı araştırılmıştır.

Bulgular: 4-18 yaş aralığında 29 erkek, 15 kız hasta çalışmaya dahil edildi. Lezyonların tümü apendiküler iskelet yerleşimli olup aksial iskelet tutulumu saptanmadı. Kırkdört lezyondan 40’ı uzun kemiklerde yerleşmişti. Bir lezyon patella, iki lezyon talus, bir lezyon kalkaneus yerleşimli idi. Kırk uzun kemik tutulumunun 34’ü alt ekstremiteleri tutmuştu. Altı olgu intraartiküler yerleşimli olup etkilenen eklemde effüzyon artmı vardı. Tüm olgularda BT ile değerlendirme yapılırken 18 olguda MRG ile de değerlendirme yapılmıştı. Öncelikli tercih edilen kesitsel görüntüleme modalitesi 35 olguda, BT iken 9 olguda MRG idi. BT tüm osteoid osteoma lezyonlarını doğru olarak tanırken, MRG’nin lezyonları tanımadaki başarısı %56 idi.

Sonuç: Osteoid osteomayı tespit etmede ve lezyonu karakterize etmede BT, MRG’den daha başarılı bulunmuştur. Çocuk ve adolesanlarda eklem effüzyonu varlığında ayırıcı tanıda intraartiküler osteoid osteoma da akılda bulundurulmalıdır.

Keywords

osteoid osteoma, çocuk, radyoloji, tanısal görüntüleme

IMAGING FINDINGS OF OSTEOID OSTEOMAS IN CHILDREN AND ADOLESCENTS, CT VERSUS MRI: A SINGLE CENTER EXPERIENCE

Abstract

Objective: To analyze osteoid osteomas of the pediatric age group, assess the distribution of lesions, and radiological findings, and compare the ability of Computerized Tomography (CT) and Magnetic Resonance Imaging (MRI) in detecting the tumor.

Material and Methods: Forty-four lesions of osteoid osteoma in children and adolescents were retrospectively analyzed using hospital files and institutional picture archiving and communication systems. Age, gender, treatment choices, modality used for diagnosis, tumor site, location within the bone, presence of calcified nidus, perilesional reactive sclerosis, cortical thickening, perilesional bone marrow edema, and joint effusion were documented.

Results: Twenty-nine males and 15 females with a median age of 15.00 (range: 4-18 years) were included in the study. All of the lesions were located in the appendicular skeleton. No axial skeletal involvement was found. Forty out of 44 lesions were located in the long bones. One was localized in the patella, 2 of them in the talus and 1 in the calcaneus. Thirty-four out of forty long bone involvement were in lower extremities. Six cases were located intraarticularly and joint effusion was seen in the involved joint. CT was available in all patients and MRI was available in 18 patients. CT was the first choice of cross-sectional imaging modality in 35 patients, and MRI was the first choice in 9 patients. MRI was successful in only 56% of the cases in characterizing osteoid osteomas. CT was accurate to characterize all osteoid osteoma lesions.

Conclusion: CT is more successful than MRI in detecting and characterizing osteoid osteomas. Intraarticular osteoid osteoma must be kept in mind in differential diagnosis, evaluating joint synovitis in children and adolescents.

Keywords

osteoid osteoma, child, radiology, diagnostic imaging

References

• 1. Bergstrand H. Über eine eigenartige, wahrscheinlich bisher nicht beschriebene osteoblastische krankheit in den langen knochen der hand und des fusses. Acta Radiol. 1930;11(6):596-613.
• 2. Laurence N, Epelman M, Markowitz RI, Jaimes C, Jaramillo D, Chauvin NA. Osteoid osteomas: a pain in the night diagnosis. Pediatr Radiol. 2012;42(12):1490-501; quiz 1540-2.
• 3. Somma F, Stoia V, D'Angelo R, Fiore F. Imaging-guided radiofrequency ablation of osteoid osteoma in typical and atypical sites: Long term follow up. PLoS One. 2021;16(3):e0248589.
• 4. Iyer RS, Chapman T, Chew FS. Pediatric bone imaging: diagnostic imaging of osteoid osteoma. AJR Am J Roentgenol. 2012;198(5):1039-52.
• 5. Graham GN, Browne H. Primary bony tumors of the pediatric spine. Yale J Biol Med. 2001;74(1):1-8.
• 6. Nakanishi M, Rosenberg DW. Multifaceted roles of PGE2 in inflammation and cancer. Semin Immunopathol. 2013;35(2):123-37.
• 7. Reverte-Vinaixa MM, Velez R, Alvarez S, Rivas A, Perez M. Percutaneous computed tomography-guided resection of non-spinal osteoid osteomas in 54 patients and review of the literature. Arch Orthop Trauma Surg. 2013;133(4):449-55.
• 8. Carneiro BC, Da Cruz IAN, Ormond Filho AG, Silva IP, Guimarães JB, Silva FD et al. Osteoid osteoma: the great mimicker. Insights Imaging. 2021;12(1):32.
• 9. Chai JW, Hong SH, Choi JY, Koh YH, Lee JW, Choi JA et al. Radiologic diagnosis of osteoid osteoma: from simple to challenging findings. Radiographics. 2010;30(3):737-49.
• 10. Virayavanich W, Singh R, O'Donnell RJ, Horvai AE, Goldsby RE, Link TM. Osteoid osteoma of the femur in a 7-month-old infant treated with radiofrequency ablation. Skeletal Radiol. 2010;39(11):1145-9.
• 11. Hart FD, Smyth JM. Osteoid osteoma in an elderly patient. Rheumatol Rehabil. 1981;20(2):106-7.
• 12. Kransdorf MJ, Stull MA, Gilkey FW, Moser RP Jr. Osteoid osteoma. Radiographics. 1991;11(4):671-96.
• 13. Ciftdemir M, Tuncel SA, Usta U. Atypical osteoid osteomas. Eur J Orthop Surg Traumatol. 2015;25(1):17-27.
• 14. Kayser F, Resnick D, Haghighi P, Pereira Edo R, Greenway G, Schweitzer M et al. Evidence of the subperiosteal origin of osteoid osteomas in tubular bones: analysis by CT and MR imaging. AJR Am J Roentgenol. 1998;170(3):609-14.
• 15. Rimondi E, Mavrogenis AF, Rossi G, Ciminari R, Malaguti C, Tranfaglia C et al. Radiofrequency ablation for non-spinal osteoid osteomas in 557 patients. Eur Radiol. 2012;22(1):181-8.
• 16. Rehnitz C, Sprengel SD, Lehner B, Ludwig K, Omlor G, Merle C et al. CT-guided radiofrequency ablation of osteoid osteoma: correlation of clinical outcome and imaging features. Diagn Interv Radiol. 2013;19(4):330-9.
• 17. Spouge AR, Thain LM. Osteoid osteoma: MR imaging revisited. Clin Imaging. 2000;24(1):19-27.
• 18. Liu PT, Chivers FS, Roberts CC, Schultz CJ, Beauchamp CP. Imaging of osteoid osteoma with dynamic gadolinium-enhanced MR imaging. Radiology. 2003;227(3):691-700.
• 19. Gaeta M, Minutoli F, Pandolfo I, Vinci S, D'Andrea L, Blandino A. Magnetic resonance imaging findings of osteoid osteoma of the proximal femur. Eur Radiol. 2004;14(9):1582-9.
• 20. Davies M, Cassar-Pullicino VN, Davies AM, McCall IW, Tyrrell PN. The diagnostic accuracy of MR imaging in osteoid osteoma. Skeletal Radiol. 2002;31(10):559-69.
• 21. Assoun J, Richardi G, Railhac JJ, Baunin C, Fajadet P, Giron J et al. Osteoid osteoma: MR imaging versus CT. Radiology. 1994;191(1):217-23.
• 22. Zanetti M, Eberhard SM, Exner GU, von Hochstetter A, Hodler J. Magnetic resonance tomography in osteoid osteoma: more confusion than benefit? Praxis (Bern 1994). 1997;86(11):432-6.
• 23. Hosalkar HS, Garg S, Moroz L, Pollack A, Dormans JP. The diagnostic accuracy of MRI versus CT imaging for osteoid osteoma in children. Clin Orthop Relat Res. 2005;433:171-7.
• 24. Seniaray N, Jain A. Osteoid Osteoma Mimicking Inflammatory Synovitis. Indian J Nucl Med. 2017;32(3):194-7.
• 25. Liu PT, Chivers FS, Roberts CC, Schultz CJ, Beauchamp CP. Imaging of osteoid osteoma with dynamic gadolinium-enhanced MR imaging. Radiology. 2003;227(3):691-700.
• 26. Zampa V, Bargellini I, Ortori S, Faggioni L, Cioni R, Bartolozzi C. Osteoid osteoma in atypical locations: the added value of dynamic gadolinium-enhanced MR imaging. Eur J Radiol. 2009;71(3):527-35.