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Osteoid Osteoma: CT-guided Percutaneous Resection and Follow-up in 38 Patients1

Nicolas Sans, MD, Denise Galy-Fourcade, MD, Jacques Assoun, MD, Thierry Jarlaud, MD, Hélène Chiavassa, MD, Paul Bonnevialle, MD, Nadine Railhac, MD, Jacques Giron, MD, Hélène Morera-Maupomé, MD and Jean-Jacques Railhac, MD

1 From the Central Medical Imaging Service, Centre Hospitalier Universitaire Purpan, Place du Docteur Baylac, F-31059 Toulouse, France. Received July 21, 1998; revision requested August 13; final revision received December 3; accepted March 16, 1999. Address reprint requests to N.S. (e-mail: sans.n@chu-toulouse.fr).



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  		Figure 1. Photograph of the drill resection system shows (left to right) guide wire, trocar, 11-mm-diameter external sheath, 9-mm-diameter toothed drill, and 9-mm-diameter drill.

 


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  		Figure 2. Photograph of the coaxial system assembled for resection.

 


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  		Figure 3a. Images obtained in a 21-year-old woman. (a) Axial CT scan obtained with contiguous 2-mm sections demonstrates a typical 5-mm-diameter calcified nidus (arrow) of osteoid osteoma of the distal femur. (b) Sagittal T1-weighted fat-saturated magnetic resonance image (repetition time, 642 msec; echo time, 12 msec) with contrast enhancement shows localized enhancement and demonstrates the inflammatory reaction (arrow) near the osteoid osteoma (arrowhead). (c) Axial CT scan obtained with the patient in the prone position shows the guide wire being inserted into the nidus (arrow). (d) Postprocedural reformatted two-dimensional sagittal CT image shows complete excision (arrow) of the nidus.

 


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  		Figure 3b. Images obtained in a 21-year-old woman. (a) Axial CT scan obtained with contiguous 2-mm sections demonstrates a typical 5-mm-diameter calcified nidus (arrow) of osteoid osteoma of the distal femur. (b) Sagittal T1-weighted fat-saturated magnetic resonance image (repetition time, 642 msec; echo time, 12 msec) with contrast enhancement shows localized enhancement and demonstrates the inflammatory reaction (arrow) near the osteoid osteoma (arrowhead). (c) Axial CT scan obtained with the patient in the prone position shows the guide wire being inserted into the nidus (arrow). (d) Postprocedural reformatted two-dimensional sagittal CT image shows complete excision (arrow) of the nidus.

 


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  		Figure 3c. Images obtained in a 21-year-old woman. (a) Axial CT scan obtained with contiguous 2-mm sections demonstrates a typical 5-mm-diameter calcified nidus (arrow) of osteoid osteoma of the distal femur. (b) Sagittal T1-weighted fat-saturated magnetic resonance image (repetition time, 642 msec; echo time, 12 msec) with contrast enhancement shows localized enhancement and demonstrates the inflammatory reaction (arrow) near the osteoid osteoma (arrowhead). (c) Axial CT scan obtained with the patient in the prone position shows the guide wire being inserted into the nidus (arrow). (d) Postprocedural reformatted two-dimensional sagittal CT image shows complete excision (arrow) of the nidus.

 


View larger version (165K):

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  		Figure 3d. Images obtained in a 21-year-old woman. (a) Axial CT scan obtained with contiguous 2-mm sections demonstrates a typical 5-mm-diameter calcified nidus (arrow) of osteoid osteoma of the distal femur. (b) Sagittal T1-weighted fat-saturated magnetic resonance image (repetition time, 642 msec; echo time, 12 msec) with contrast enhancement shows localized enhancement and demonstrates the inflammatory reaction (arrow) near the osteoid osteoma (arrowhead). (c) Axial CT scan obtained with the patient in the prone position shows the guide wire being inserted into the nidus (arrow). (d) Postprocedural reformatted two-dimensional sagittal CT image shows complete excision (arrow) of the nidus.

 




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