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Journal of the American College of... Apr 2024Compare the cost of performing an osteoid osteoma ablation using cone beam CT (CBCT) with overlay fluoroscopic guidance to ablation using conventional CT (CCT) guidance...
OBJECTIVE
Compare the cost of performing an osteoid osteoma ablation using cone beam CT (CBCT) with overlay fluoroscopic guidance to ablation using conventional CT (CCT) guidance and microwave ablation (MWA) to radiofrequency ablation (RFA).
METHODS
An 11-year retrospective study was performed of all patients undergoing osteoid osteoma ablation. Ablation equipment included a Cool tip RFA probe (Covidien, Minneapolis, Minnesota) or a Neuwave PR MWA probe (Ethicon, Rariton, New Jersey). The room times as well as immediate recovery time were recorded for each case. Cost analysis was then performed using time-driven activity-based costing for rate-dependent variables including salaries, equipment depreciation, room time, and certain supplies. Time-independent costs included the disposable interventional radiology supplies and ablation systems. Costs were reported for each service providing care and using conventional cost accounting methods with variable and fixed expenditures.
RESULTS
A total of 91 patients underwent 96 ablation procedures in either CBCT (n = 66) or CCT (n = 30) using either MWA (n = 51) or RFA (n = 45). The anesthesia induction (22.7 ± 8.7 min versus 15.9 ± 7.2 min, P < .001), procedure (64.7 ± 27.5 min versus 47.3 ± 15.3 min; P = .001), and room times (137.7 ± 33.7 min versus 103.9 ± 22.6. min; P < .001) were significantly longer for CBCT procedures. The procedure time did not differ significantly between MWA and RFA (62.1 ± 27.4 min versus 56.1 ± 23.3 min; P = .27). Multiple regression analysis demonstrated lower age (P = .046), CBCT use (P = .001), RFA use (P = .02), and nonsupine patient position (P = .01) significantly increased the total procedural cost. After controlling for these variables, the total cost of CBCT ($5,981.32 ± $523.93 versus $5,378.93 ± $453.12; P = .001) remained higher than CCT and the total cost of RFA ($5,981.32 ± $523.93 versus $5,674.43 ± $549.14; P = .05) approached a higher cost than MWA.
CONCLUSION
The use of CBCT with overlay fluoroscopic guidance for osteoid osteoma ablation resulted in longer in-room times and greater cost when compared with CCT. These cost considerations should be weighed against potential radiation dose advantage of CBCT when choosing an image guidance modality. Younger age, RFA use, and nonsupine patient position additionally contributed to higher costs.
Topics: Humans; Bone Neoplasms; Osteoma, Osteoid; Retrospective Studies; Catheter Ablation; Ablation Techniques; Costs and Cost Analysis; Treatment Outcome
PubMed: 37473855
DOI: 10.1016/j.jacr.2023.02.035 -
Imaging Science in Dentistry Mar 2024A 54-year-old male patient presented for a periodic check-up at the dental clinic. A panoramic radiograph showed bilateral ossification of the stylohyoid ligament with...
A 54-year-old male patient presented for a periodic check-up at the dental clinic. A panoramic radiograph showed bilateral ossification of the stylohyoid ligament with an oval radiopacity on the right side. Cone-beam computed tomography revealed a well-defined, homogenous hyperdense entity from the lower third of the ossified stylohyoid ligament on the right side. The differential diagnosis of osteoma on the stylohyoid chain includes Eagle syndrome and benign tumors of the stylohyoid chain and adjacent structures. Osteoma rarely manifests in the neck. Even more infrequent are tumors originating from the stylohyoid chain, with only a single documented case of osteoma reported in the literature in 1993. Due to the asymptomatic status, no surgical intervention was advised, and the case would be monitored periodically. This case report describes the details of an osteoma that emerged from the stylohyoid chain, marking it as the second recorded occurrence of this highly rare condition.
PubMed: 38571770
DOI: 10.5624/isd.20230222 -
British Journal of Neurosurgery Oct 2023Osteoid osteoma occasionally occur in the spine, but their malignant transformation is not common. We present an extremely rare case of the malignant transformation of... (Review)
Review
PURPOSE
Osteoid osteoma occasionally occur in the spine, but their malignant transformation is not common. We present an extremely rare case of the malignant transformation of an osteoid osteoma to high-grade osteosarcoma that formed in the pedicle and spread to the lateral mass of the cervical spine.
CASE PRESENTATION
We report the case of an 18-year-old man who suffered from neck pain as an initial symptom. The size of the radiolucent lesion was 12 mm in diameter at the time of diagnosis. Intralesional tumour resection and autologous bone grafting were performed. The remaining tumour grew gradually for 40 months after the surgery; therefore, the tumour had grown rapidly till 51 months after the initial diagnosis. At this stage, the tumour size was approximately 6-fold larger than the initial size, and resulted in progressive paraplegia. A biopsy revealed that the tumour had transformed into a high-grade osteosarcoma. Heavy charged particle irradiation was performed to control tumour growth.
CONCLUSIONS
There is a possibility of malignant transformation of osteoid osteoma. Patients with osteoid osteoma or osteoblastoma should be carefully observed, especially for recurrent tumours after an intralesional resection.
Topics: Male; Humans; Adolescent; Osteoma, Osteoid; Neoplasm Recurrence, Local; Osteoblastoma; Osteosarcoma; Cervical Vertebrae; Cell Transformation, Neoplastic; Bone Neoplasms
PubMed: 33140986
DOI: 10.1080/02688697.2020.1842326 -
Orbit (Amsterdam, Netherlands) Feb 2024Gardner syndrome (GS) is a rare genetic disorder characterized by numerous intestinal colon polyps with various extraintestinal manifestations. Osteomas are a known... (Review)
Review
Gardner syndrome (GS) is a rare genetic disorder characterized by numerous intestinal colon polyps with various extraintestinal manifestations. Osteomas are a known extracolonic manifestation of GS and can affect the orbit, as seen in our patient, as well as 13 other cases documented in literature. Excision of large orbital osteomas can be successful with a multi-disciplinary approach as presented in this article. Ophthalmologists can even be the first to diagnose GS, usually via the presence of congenital hypertrophy of the retinal pigment epithelium (CHRPE) lesions. Untreated, 100% of colon polyps will transform into cancer, thus it is important to be aware of this rare syndrome with ophthalmic manifestations and screen patients with osteomas for GS.
Topics: Humans; Gardner Syndrome; Osteoma
PubMed: 35652300
DOI: 10.1080/01676830.2022.2080231 -
Case Reports in Otolaryngology 2023Temporal bone osteomas comprise 0.1-1% of benign tumors involving the skull, the majority of which arise in the external auditory canal. More rarely, they can arise from...
Temporal bone osteomas comprise 0.1-1% of benign tumors involving the skull, the majority of which arise in the external auditory canal. More rarely, they can arise from the mastoid portion of the temporal bone. These generally present as a slow growing skull base lesion that can cause cosmetic deformity, headache, and/or hearing loss. Here, we report a case of extracanalicular mastoid osteoma uniquely presenting with posterior fossa and cerebellar compression with associated dizziness and imbalance.
PubMed: 38143514
DOI: 10.1155/2023/6652012 -
Lin Chuang Er Bi Yan Hou Tou Jing Wai... Jun 2024To investigate the criteria for selecting surgical approaches for frontal and ethmoid sinus osteomas of different locations and sizes on CT imaging. Using sagittal and...
To investigate the criteria for selecting surgical approaches for frontal and ethmoid sinus osteomas of different locations and sizes on CT imaging. Using sagittal and coronal CT images, the following lines were delineated: the F-line(a horizontal line passing nasofrontal beak), the M-line(a vertical line passing paries medialis orbitae), and the P-line(a vertical line passing the center of the pupil). Classification of frontal and ethmoid sinus osteomas was based on their relationship with these lines. Appropriate surgical approaches were selected, including pure endoscopic approaches, endoscopic combined with eyebrow incision approach, and endoscopic combined with coronal incision approach. This method was applied to a single center at the Third Affiliated Hospital of Sun Yat-sen University for endoscopic resection of frontal and ethmoid sinus osteoma. Case Data: Sixteen cases of ethmoid sinus osteomas were treated from January 2020 to September 2023. Among these cases, there were 9 males and 7 females, with ages ranging from 18 to 69 years, and a median age of 48 years. Thirteen cases underwent pure endoscopic resection of the osteoma, while in three cases, a combined approach was utilized. Among the combined approach cases, two exceeded both the M-line and the F-line but did not cross the P-line; therefore, they underwent endoscopic combined with eyebrow incision approach. One case exceeded all three lines and thus underwent endoscopic combined with coronal incision. In all cases, complete resection of the osteoma was achieved as per preoperative planning, and none of the patients experienced significant postoperative complications. For frontal and ethmoid sinus osteomas, it is advisable to perform a thorough preoperative radiological assessment. Based on the size of the osteoma and its relationship to the three lines, an appropriate surgical approach should be chosen to optimize the diagnostic and treatment plan.
Topics: Humans; Osteoma; Male; Female; Middle Aged; Adult; Aged; Frontal Sinus; Ethmoid Sinus; Adolescent; Tomography, X-Ray Computed; Paranasal Sinus Neoplasms; Endoscopy; Young Adult
PubMed: 38858119
DOI: 10.13201/j.issn.2096-7993.2024.06.013 -
European Journal of Medical Genetics Apr 2024Familial Adenomatous Polyposis (FAP) is a colorectal cancer (CRC) predisposition syndrome caused by germline APC mutations and characterised by an increased risk of CRC...
BACKGROUND
Familial Adenomatous Polyposis (FAP) is a colorectal cancer (CRC) predisposition syndrome caused by germline APC mutations and characterised by an increased risk of CRC and colonic polyps and, in certain forms, of specific prominent extraintestinal manifestations, namely osteomas, soft tissue tumours and dental anomalies. Pachydysostosis of the fibula is a rare clinical entity defined by unilateral bowing of the distal portion of the fibula and elongation of the entire bone, without affectation of the tibia.
CLINICAL REPORT
We report a 17-year-old male, who presented with a non-progressive bowing of the right leg detected at 18 months of age caused by a fibula malformation (later characterized as pachydysostosis) and a large exophytic osteoma of the left radius, noticed at the age of 15 years, without gastrointestinal symptoms. There was no relevant family history. Detailed characterisation revealed multiple osteomas, skin lesions and dental abnormalities, raising the hypothesis of FAP. This diagnosis was confirmed by genetic testing [c.4406_4409dup p.(Ala1471Serfs*17) de novo mutation in the APC gene] and endoscopic investigation (multiple adenomas throughout the colon, ileum and stomach).
DISCUSSION
This case report draws attention to the phenotypic spectrum of skeletal manifestations of FAP: this patient has a congenital fibula malformation, not previously associated with this syndrome, but which is likely to have been its first manifestation in this patient. This clinical case also illustrates the challenges in the early diagnosis of FAP, especially without family history, and highlights the importance of a multidisciplinary approach and the adequate study of rare skeletal abnormalities.
Topics: Male; Humans; Adolescent; Adenomatous Polyposis Coli Protein; Fibula; Adenomatous Polyposis Coli; Genes, APC; Germ-Line Mutation; Osteoma
PubMed: 38286305
DOI: 10.1016/j.ejmg.2024.104913 -
Diagnostic and Interventional Imaging Jan 2024The purpose of this study was to evaluate the ability to depict in vivo bone vascularization using ultra-high-resolution (UHR) computed tomography (CT) with deep...
PURPOSE
The purpose of this study was to evaluate the ability to depict in vivo bone vascularization using ultra-high-resolution (UHR) computed tomography (CT) with deep learning reconstruction (DLR) and hybrid iterative reconstruction algorithm, compared to simulated conventional CT, using osteoid osteoma as a model.
MATERIALS AND METHODS
Patients with histopathologically proven cortical osteoid osteoma who underwent UHR-CT between October 2019 and October 2022 were retrospectively included. Images were acquired with a 1024 × 1024 matrix and reconstructed with DLR and hybrid iterative reconstruction algorithm. To simulate conventional CT, images with a 512 × 512 matrix were also reconstructed. Two radiologists (R1, R2) independently evaluated the number of blood vessels entering the nidus and crossing the bone cortex, as well as vessel identification and image quality with a 5-point scale. Standard deviation (SD) of attenuation in the adjacent muscle and that of air were used as image noise and recorded.
RESULTS
Thirteen patients with 13 osteoid osteomas were included. There were 11 men and two women with a mean age of 21.8 ± 9.1 (SD) years. For both readers, UHR-CT with DLR depicted more nidus vessels (11.5 ± 4.3 [SD] (R1) and 11.9 ± 4.6 [SD] (R2)) and cortical vessels (4 ± 3.8 [SD] and 4.3 ± 4.1 [SD], respectively) than UHR-CT with hybrid iterative reconstruction (10.5 ± 4.3 [SD] and 10.4 ± 4.6 [SD], and 4.1 ± 3.8 [SD] and 4.3 ± 3.8 [SD], respectively) and simulated conventional CT (5.3 ± 2.2 [SD] and 6.4 ± 2.5 [SD], 2 ± 1.2 [SD] and 2.4 ± 1.6 [SD], respectively) (P < 0.05). UHR-CT with DLR provided less image noise than simulated conventional CT and UHR-CT with hybrid iterative reconstruction (P < 0.05). UHR-CT with DLR received the greatest score and simulated conventional CT the lowest score for vessel identification and image quality.
CONCLUSION
UHR-CT with DLR shows less noise than UHR-CT with hybrid iterative reconstruction and significantly improves cortical bone vascularization depiction compared to simulated conventional CT.
Topics: Male; Humans; Female; Child; Adolescent; Young Adult; Adult; Osteoma, Osteoid; Deep Learning; Retrospective Studies; Radiographic Image Interpretation, Computer-Assisted; Radiation Dosage; Tomography, X-Ray Computed; Cortical Bone; Algorithms; Bone Neoplasms
PubMed: 37482455
DOI: 10.1016/j.diii.2023.07.001 -
Insights Into Imaging Mar 2024We aim to evaluate the efficacy of CT-guided percutaneous radiofrequency ablation (RFA) and surgical treatment in osteoid osteoma (OO) treated at the Medical University...
A comparative study assessing the efficacy and safety of radiofrequency ablation versus surgical treatment for osteoid osteoma: retrospective analysis in a single institution.
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.
PubMed: 38517657
DOI: 10.1186/s13244-024-01656-1 -
Cureus Oct 2023Osteoid osteomas (OOs) are non-malignant primary bone abnormalities marked by a central nidus surrounded by reactive sclerosis. They typically manifest as aggravated...
Osteoid osteomas (OOs) are non-malignant primary bone abnormalities marked by a central nidus surrounded by reactive sclerosis. They typically manifest as aggravated nocturnal pain that responds to non-steroidal anti-inflammatory drugs (NSAIDs). These growths are most frequently found within the intracortical bone and the diaphysis of elongated bones. Within the realm of uncommon conditions, intra-articular OOs (IAOOs) exhibit distinctive presentations, often leading to postponed or inaccurate diagnoses. We present a patient with OO at the distal femur, accessible through the knee joint, which was intraoperatively identified and localized using a and treated by arthrotomy and mosaicplasty.
PubMed: 38021561
DOI: 10.7759/cureus.47393