DOI:10.2214/AJR.08.1450
AJR 2008; 191:W320
© American Roentgen Ray Society
Radiofrequency Ablation of Solitary Eosinophilic Granuloma of Bone
Peter L. Munk1,
David Malfair1,
Faisal Rashid1 and
William C. Torreggiani2
1 Vancouver General Hospital University of British Columbia Vancouver, BC,
Canada
2 Adelaide and Meath Hospitals Tallaght, Dublin, Ireland
WEB—This is a Web exclusive article.
We have read with considerable interest the article by Corby et al.
[1], "Radiofrequency
Ablation of Solitary Eosinophilic Granuloma of Bone." The authors
correctly point out that radiofrequency ablation potentially may be a useful
option in the treatment of this benign but often highly symptomatic disease
without entailing the morbidity of more-invasive procedures. This has
certainly proven to be the case in the radiofrequency treatment of osteoid
osteoma, which as the authors well know is typically an appendicular
affliction and has been treated with considerable success over the past 20
years.
The two patients reported by Corby et al.
[1] had lesions that were
considerably larger than the typical osteoid osteoma and would require an
umbrella probe of the type Corby et al. used for effective ablation. In the
case of their first patient, who had a femoral diaphyseal lesion, virtually
the entire cross-sectional diameter of the bone was taken up by abnormal
tissue. In our experience and that of others, if MRI is performed following
radiofrequency ablation, a large area of necrosis is induced. In the case of a
long tubular bone with a lesion occupying the entire medullary space, one
would expect that the whole of the cross-sectional diameter of the bone would
be necrotic. Depending on the amount of heat penetration through the overlying
cortex (i.e., the amount of damage), the bone could be appreciably weakened.
In this setting, the patient may be prone to a pathologic fracture. In the
case of the first patient shown by the authors, considerable buttressing of
periosteal new bone was present, which undoubtedly would have been helpful in
preventing a pathologic fracture from developing. However, we would caution
that it should be borne in mind that this should be carefully considered when
offering this therapy, particularly in a long bone that is weight-bearing.
Corby et al. [1] correctly
point out that in some weight-bearing areas, such as the acetabulum, it may
potentially be advantageous to inject methylmethacrolate cement
(acetabuloplasty) to provide mechanical support. Certainly, considerable
efficacy in the treatment of metastatic disease of the acetabulum has been
reported with combined radiofrequency and cement injection therapy by a number
of authors as well as by us. Toyota et al.
[2] have reported their
experience and found it highly effective in palliation.
References
- Corby RR, Stacy GS, Peabody TD, Dixon LB. Radiofrequency ablation
of solitary eosinophilic granuloma of bone. AJR2008; 190:1492
-1494[Abstract/Free Full Text]
- Toyota N, Naito A, Kakizawa H, et al. Radiofrequency ablation
combined with cementoplasty for painful bone metastases: initial experience.
Cardiovasc Intervent Radiol2005; 28:578
-583[Medline]
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