Establishing a clinical service for the treatment of osteoid osteoma using magnetic resonance-guided focused ultrasound: overview and guidelines

Abstract

Recent studies have demonstrated the effectiveness of magnetic resonance-guided focused ultrasound (MRgFUS) in the treatment of osteoid osteoma (OO), a painful, benign bone tumor. As MRgFUS is a noninvasive and radiation-free treatment, it stands to replace the current standard of care, percutaneous radiofrequency, or laser thermal ablation. Within an institution, creation of a clinical OO MRgFUS treatment program would not only provide cutting edge medical treatment at the current time but would also establish the foundation for an MRgFUS clinical service to introduce treatments currently under development into clinical practice in the future. The purpose of this document is to provide information to facilitate creation of a clinical service for MRgFUS treatment of OO by providing (1) recommendations for the multi-disciplinary management of patients and (2) guidelines regarding current best practices for MRgFUS treatment. This paper will discuss establishment of a multi-disciplinary clinic, patient accrual, inclusion/exclusion criteria, diagnosis, preoperative imaging, patient preparation, anesthesia, treatment planning, targeting and treatment execution, complication avoidance, and patient follow-up to assure safety and effectiveness.

Intra-articular osteoid osteoma as a differential diagnosis of diffuse mono-articular joint pain

“…In our case, it has to be expected that the necrosis zone will only revitalize very slowly, if at all. The use of alternative methods including tissue impedance as a parameter of osteonecrosis [25] or magnetic resonance-guided focused ultrasound [26] might be promising and gentle alternatives. Nonetheless, further investigation including large multi-center studies is needed to compare outcomes between these new methods and RFA.…”

Noninvasive Therapy for Osteoid Osteoma: A Prospective Developmental Study with MR Imaging–guided High-Intensity Focused Ultrasound

“…This work fulfilled the 2a stage component of the IDEAL guidelines for evaluating novel surgical strategies (20); the logical subsequent step should be a randomized trial to compare MR imaging-guided HIFU with CT-guided RFA (the standard of care) in terms of clinical efficacy and adverse events (stage 3). Alternatively, a multiple-nation registry of MR imaging-guided HIFU treatment for nonvertebral osteoid osteoma might be a feasible option for gathering sufficient data that could be used as a base for comparisons with CTguided RFA (35). The Focused Ultrasound Foundation is providing funding support for the creation of an MR imaging-guided HIFU osteoid osteoma treatment registry.…”

Effect of Sonication Duration and Power on Ablation Depth During MR‐Guided Focused Ultrasound of Bone

“…The technique is US Food and Drug Administration (FDA)‐approved for treatment of uterine fibroids, palliation of bone metastases, and essential tremor . In addition to these indications, MRgFUS is actively used for a wide range of focal musculoskeletal conditions, including benign bone tumors (eg, osteoid osteomas), soft‐tissue tumors (eg, desmoid tumors), and joint pain, for example, lower back pain secondary to facet joint arthropathy …”

“…[2][3][4][5] In addition to these indications, MRgFUS is actively used for a wide range of focal musculoskeletal conditions, including benign bone tumors (eg, osteoid osteomas), soft-tissue tumors (eg, desmoid tumors), and joint pain, for example, lower back pain secondary to facet joint arthropathy. [6][7][8][9] The use of MRgFUS for ablations within and adjacent to bone poses several important challenges. As sound energy reaches a bone-soft tissue interface, there is marked attenuation secondary to reflection, absorption, scatter, and mode conversion so that as much as 60-80% of the acoustic energy is attenuated.…”