- Oral presentation
- Open Access
Magnetic resonance guided focused ultrasound for noninvasive pain therapy of osteoid osteoma in children
© Waspe et al; licensee BioMed Central Ltd. 2015
Published: 30 June 2015
Osteoid osteoma (OO), a small painful benign bone tumor, is the most common bone tumor in children. Pain is managed with nonsteroidal anti-inflammatory drugs but minimally invasive techniques, such as CT-guided laser ablation, have become a standard intervention. However, the potential for non-target injury is a concern as tissue temperature cannot be measured with CT and the laser induces temperatures >90°C for 10 minutes. It also includes risks from exposure to ionizing radiation, fracture, infection and transmitted thermal damage from the access needle. Magnetic resonance guided high intensity focused ultrasound (MRgHIFU) has been used successfully in small cohorts of adults with OO. The noninvasive nature of the energy means that procedures do not need to be conducted in a sterile environment since there is no mechanical penetration of the bone, reducing the chance of pathologic fracture and infection.
A Philips Sonalleve MRgHIFU device is being used to thermally ablate OO in pediatric patients. MR provides excellent soft tissue contrast, which enhances the interface between bone and surrounding soft tissues as well as the highly vascularized core of the OO, known as the nidus. The nidus is the primary target of thermal OO treatments since destroying it will prevent regrowth of this painful lesion. Ten patients will be recruited and complete age-appropriate and validated surveys (Pediatric Ouch, and PedsQLTM) to determine how lesion/bone pain and medication usage affects health-related quality of life (HRQL) metrics, such as physical, emotional, social, and school functioning. A planning MRI will be used to ensure lesion accessibility/patient eligibility and MR thermometry will measure temperature in the target and surrounding tissue to ensure patient safety. As thermal bone ablation is painful, patients will be under general anesthesia for the treatment. Follow-up on days 2, 7, 14, 30, 90 and 180 following treatment will record pain, HRQL, and drug usage. Clinical visits on days 30, 90 and 180 will comprise a physical examination and a diagnostic MRI of the OO. Contrast enhanced MRI will indicate non-perfused tissues corresponding to the ablated tissue volume, which should be fully resolved by day 180.
Results and conclusions
We acknowledge project funding from the Focused Ultrasound Foundation and the Hospital for Sick Children Innovation Fund. This clinical study is not industry sponsored but we do receive technical support from Philips Healthcare and collaborate with Philips on preclinical focused ultrasound projects.
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