osteoid osteoma

Osteoid
osteoma of the fibula in computed tomography (bone window). The nidus is clearly visible. (The small point dorsally in the tibia is not an OO, but a vessel canal, which is typical at this point.)
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Lesions
involving the outer surface of the bone in children: a pictorial review. Sub-periosteal osteoid osteoma. A 15-year-old boy with sub-periosteal osteoid osteoma involving the right femur. Coronal a and axial b non-enhanced CT images show cortical thickening with reactive sclerosis (arrow) involving the postero-medial cortex of the femur, surrounding a low-attenuation nidus with central mineralization. Coronal STIR c and axial T1 post-contrast d images show avid contrast enhancement and edema within the bone marrow and soft tissue surrounding the nidus. The periphery of the nidus enhances more intensely than the central portion (arrow)
insightsimaging.springeropen.com • Open Access
Teenager with
back pain and scoliosisAP radiograph of the thoracic spine shows an indistinct margin of the left T10 pedicle and mild scoliosis convex right. Axial CT without contrast of the T10 vertebral body with coronal and sagittal 2-D reconstructions shows a small round lucent nidus with central calcification in the left T10 pedicle surrounded by sclerosis.The diagnosis was osteoid osteoma.
pediatricimaging.org • CC-by-nc-sa 4.0
Osteoid
osteoma of the femoral head treated by radiofrequency ablation: a case report. Plain radiograph in anteroposterior view showing a well defined lytic lesion with a thin sclerotic rim located in the subarticular portion of the left femoral head (white arrow).
jmedicalcasereports.biomedcentral.com • CC-by-2.0
School ager
with right thigh mass. AP radiograph of the femur (above left) shows tremendous cortical thickening of the femoral diaphysis. Axial CT without contrast of the femur (above right) shows a round lucent lesion with central calcification within the center of the tremendously thickened cortex. Axial T2 MRI (middle) through the lesion shows a tremendous amount of edema surrounding the thickened cortex of the right femur. Coronal T1 MRI without (below left) and with (below right) contrast of the femur shows the lesion to enhance.The diagnosis was osteoid osteoma.
pediatricimaging.org • CC-by-nc-sa 4.0
Osteoidosteom
der Tibia in der Computertomographie (rechts Knochenfenster nativ, links Kontrastmitteldynamik). Man erkennt den kortikalen Defekt und die umgebende Sklerose. In der KM-Dynamik zeigt die untere Kurve den Dichteanstieg in der Arterie nach KM-Gabe, die oberste Kurve den parallel dazu verlaufenden Anstieg im Osteoidosteom.
Wikipedia • CC BY-SA 3.0
Osteoid
osteoma: the great mimicker. Pattern of enhancement of osteoid osteoma. Male, 17 years old, presenting with metatarsalgia of the right foot for 2 months, which became worse over the past week. He had no recollection of trauma and practiced sports regularly. CR (a) showed no significant findings, apart from mild bone sclerosis in the middle phalanx of the second toe (arrowhead). Coronal T1 and T2WI (b, c) depicted marked edema of the bone marrow and surrounding tissues (curved arrow) and a very small intracortical lesion (dashed arrow). Dynamic MR angiography (d–f) showed marked enhancement of the intracortical nodule (arrow in d), presenting contrast kinetics similar to those of adjacent arteries, with a peak enhancement followed by rapid washout, suggestive of OO (e, f). A CT scan (g, h) was later performed, and the findings confirmed the presence of a nidus (arrows)
insightsimaging.springeropen.com • CC-by-4.0
Osteoid
osteoma: the great mimicker. Typical osteoid osteoma and percutaneous ablation. Male, 15 years old, presenting with medial hip pain for 2 months, which became worse at night. Axial T1 (a) and T2 FS (b) MR images showing a small cortical nidus (arrows) within the femur shaft with a target-like appearance, edema and sclerosis. CT (c) better detected the partially mineralized nidus (dotted arrow), cortical thickening and sclerosis than did MRI. CT percutaneous biopsy and radiofrequency ablation (d) were performed (dashed arrow)
insightsimaging.springeropen.com • CC-by-4.0
Osteoid
osteoma: the great mimicker. Osteoid osteoma near a growth plate. An 11–year-old male with a history of surgical removal of an OO on the distal metadiaphysis of the left femur. His symptoms persisted, and follow-up MRI (a, b) and CT (c) showed a residual nidus at the medial femoral margin represented by the intracortical nodule (arrows) and surrounding bone marrow edema (asterisk in b). In a, note that the affected side of the distal femur is longer than the lateral side, resulting in a femoral deformity and length discrepancy of the left lower limb
insightsimaging.springeropen.com • CC-by-4.0
Osteoid
osteoma: the great mimicker. Osteoid osteoma mimicking synovitis of the hip. A 24-year-old man with right hip pain, swelling and tenderness for 2 weeks. Inflammatory marker levels were also elevated. Orthopedists suspected inflammatory arthropathy, and ultrasound (not shown) depicted joint effusion and synovitis. MRI T2 FS sagittal (a) and axial (b) shows joint effusion (arrowhead) with synovial thickening and a doubtful nidus (arrow), which was better characterized on the CT scan (c). Arthroscopic aspect before (d) and after (e) nidus resection
insightsimaging.springeropen.com • CC-by-4.0
Osteoid
osteoma: the great mimicker. Osteoid osteoma mimicking synovitis on the elbow. Female, 20 years old, with elbow pain and edema for 4 months. Ultrasound in anterior sagittal view (a) at the coronoid fossa level shows joint effusion (arrow). MRI T1 (b) and T2FS (c, d) show bone marrow edema (dotted arrows) and synovitis (dashed arrows). Further investigation with a CT scan (e, f) revealed a mineralized nidus (curved arrow) in the cancellous bone of the medial humeral condyle
insightsimaging.springeropen.com • CC-by-4.0
Osteoid
osteoma: the great mimicker. Subchondral osteoid osteoma mimicking trochlear chondromalacia. A 35-year-old male with anterior knee pain for 4 months. Axial T2 FS MR images (a) showed deep chondral erosion (arrow), subchondral edema (asterisk) and a small, low signal intensity foci that could be a nidus (dashed arrow). Sagittal T1 MRI (b) and CT (c) confirmed the diagnosis of the OO nidus (dashed arrow). Surgical images before (d) and after (e) resection
insightsimaging.springeropen.com • CC-by-4.0
Osteoid
osteoma: the great mimicker. Osteoid osteoma versus osteomyelitis. (a–d) Male, 15 years old, presenting with knee pain for 2 months. MRI T2 FS (a), T1 (b), T1 FSGD (c) and CT (d) showed a nidus with smooth margins (arrows), a central mineralized portion (dashed arrows), homogeneous gadolinium enhancement (dotted arrows) and hazy T1 bone marrow edema around the lesion (asterisk). (e–h) Male, 13 years old, presenting with knee pain for 6 weeks. MRI T2 FS (e), T1 (f), T1 FS GD (g) and CT (h) showed a bone abscess with irregular margins and peripheral enhancement (arrows). Note there was mild bone marrow edema (asterisk), a positive penumbra sign (dashed arrow in f) and a small peripheral bone sequestrum (curved arrow in h)
insightsimaging.springeropen.com • CC-by-4.0
Osteoid
osteoma: the great mimicker. Osteoid osteoma versus calcar femorale stress fracture. (a–d) Male, 35 years old, presenting with hip pain for 3 months. MRI T1 (a) and T2 FS (b) showed bone marrow edema on the femoral neck (arrowhead), T1 FS GD (c) and CT (d) showed a small nonmineralized nidus (arrows) with gadolinium enhancement (c) and mild cortical thickening (dotted arrow in d). (e–h) Male, 33-year-old runner, presenting with hip pain for 2 weeks, which worsened during running workouts. MRI T1 (e) and T2 FS (f, g) showed bone marrow edema on the lower femoral neck (arrowhead) and a cortical fracture line (arrows), which was also seen on the CT scan (h)
insightsimaging.springeropen.com • CC-by-4.0
Osteoid
osteoma: the great mimicker. Osteoid osteoma versus tibial stress syndrome. A 15-year-old male soccer player with posteromedial tibial pain for 3 months that worsened while training and upon palpation of the upper posteromedial tibia. MRI axial T1 (a), axial (b) and coronal (c) T2 FS showed cortical thickening, periosteal reaction, pes anserinus tendon edema (arrows) and bone marrow edema (asterisk), mimicking a stress syndrome. Further investigation with a CT scan (d, e, f) demonstrated a nidus (dashed arrow), causing this corticoperiosteal reaction (arrowhead) and confirming OO
insightsimaging.springeropen.com • CC-by-4.0
Osteoid
osteoma: the great mimicker. Osteoid osteoma versus subchondral fracture. (a–c) Female, 32 years old, presenting with metatarsalgia for 2 months. T1 coronal (a) and T2 FS coronal (b) and sagittal (c) MRI showed a mineralized nidus (arrows) with reactional bone marrow and adjacent edema (asterisk). (d–f) Female, 33 years old, presenting with metatarsalgia for 3 weeks. T1 sagittal (a) and T2 FS coronal (b) and sagittal (c) MRI showed a subchondral fracture (dotted arrows) with bone marrow edema (asterisk)
insightsimaging.springeropen.com • CC-by-4.0
Osteoid
osteoma: the great mimicker. Osteoid osteoma versus crystal deposition disease. (a–d) Male, 19 years old, presenting with groin pain for one year. Axial (a) and coronal (b) T2 FS MRI and CT (c) showed a small mineralized nidus (arrows) and reactional bone marrow edema (black asterisk). Percutaneous CT-guided drill excision was performed (d). (e–h) Female, 36 years old, presenting with hip pain for 5 months. Coronal (e) and axial (f) T2 FS and coronal T1 (g) MRI showed calcifications (arrows) close to the indirect head of rectus femoris (arrowheads), which were better characterized on the plain radiograph (h), with reactional bone marrow edema (asterisk)
insightsimaging.springeropen.com • CC-by-4.0
Osteoid
osteoma: the great mimicker. Osteoid osteoma versus crystal deposition disease [2]. (a–c) Male, 30 years old, presenting with posterior thigh pain for 3 months. Axial T1 (a) and axial (b) and sagittal (c) T2 FS MRI demonstrated a cortical nidus (arrows) and reactional bone marrow edema close to the gluteus tuberosity. Note that the gluteus maximus tendon (dotted arrow) insertion is below the nidus. (d–f) Female, 38 years old, presenting with very intense posterior thigh pain for 2 days. T2 FS axial and coronal MRI (d, e) and plain radiograph (f) showed corticoperiosteal and bone marrow edema in the right gluteus maximus tendon (arrows) insertion and some calcifications (dotted arrows)
insightsimaging.springeropen.com • CC-by-4.0
Osteoid
osteoma: the great mimicker. Osteoid osteoma versus glomus tumor. (a–f) Male, 19 years old, presenting with second toe clubbing and night pain (a). Sagittal T1 (b) and sagittal (c) and axial (d) T2FS MR images showed diffuse nail bed thickening (dotted arrows), with no defined nodule, as well as a low signal cortical/juxtacortical nodule at the distal phalanx (arrows), accompanied by bone marrow edema (arrowhead). A CT scan (e, f) was performed, and the findings revealed a sclerotic nodule corresponding to an OO nidus (arrows), with minimal reactional surrounding sclerosis. (g–k) Female, 53 years old, presenting with pain on the 4th finger that radiated to the forearm. Sagittal, coronal, axial T2 FS, axial T1 and T1 FS GD MR images depicted a subungual nodular well-defined lesion (arrow) with remodeling of the subjacent phalanx cortex (dotted arrow) and homogeneous enhancement after gadolinium injection (k). Note that diffuse thickening of the nail bed or phalanx sclerosis was absent.
insightsimaging.springeropen.com • CC-by-4.0
Osteoid
osteoma: the great mimicker. Osteoid osteoma versus chondroblastoma. (a–d) Male, 29 years old, presenting with knee pain for 3 months. MRI sagittal T1 (a), axial and coronal T2 FS (b, c) and CT (d) showed a round and central mineralized nidus (arrows) with reactional bone marrow edema (asterisk) and cortical thickening (dashed arrow in d). (e–h) Male, 24 years old, presenting with ankle pain for 9 months. MRI axial T1 (e), sagittal T2 (f), axial T1 FS GD (g) and CT (h) showed a large and lobulated bone lesion (arrows) with peripheral arciform calcifications (dotted arrows), internal enhancement (c) and reactional bone marrow edema (asterisk)
insightsimaging.springeropen.com • CC-by-4.0
Osteoid
osteoma: the great mimicker. Osteoid osteoma mimicking bone marrow contusion. Male, 16 years old, presenting with right elbow and arm pain for 2 days after falling during physical activity at school. First, the MRI T1 (a) and T2 FS (b, c) findings were interpreted to indicate contusion bone marrow edema (asterisks) without a fracture. However, the pain persisted for more than 3 months. Follow-up CT (d, e) and MRI (f, g) scans revealed small subchondral OO with a lytic nonmineralized nidus (arrows) and enhancement (dotted arrows) on the T1 FS GD MRI scan (f, g)
insightsimaging.springeropen.com • CC-by-4.0
School ager
with back pain. AP radiograph of the thoracic spine (left upper) shows a mild curvature of the spine convex right and the left pedicle of the T12 vertebral body is difficult to visualize. Axial CT without contrast of the T12 vertebral body (right upper) shows a lesion with a lucent nidus surrounded by a sclerotic rim in the left pedicle of the T12 vertebral body. Pinhole (left lower) and whole body (right lower) images from a nuclear medicine bone scan show focally increased radiotracer localization in the left pedicle of the T12 vertebral body and a curvature of the spine convex right.The diagnosis was painful scoliosis secondary to an osteoid osteoma in the left pedicle of the T12 vertebral body.
pediatricimaging.org • CC-by-nc-sa 4.0
Osteoid-Osteom
des distalen Radius in der Magnetresonanztomographie: Erhebliches Umgebungsödem in der fettgesättigten Sequenz.
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Osteoidosteom
am Trochanter minor: Röntgen und MRT mit deutlicher Sklerose um den Nidus.
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Primary
tumors of the patella. An intracortical osteoid osteoma of the patella. (A) On plain radiographs, a clear lesion with small fuzzy periosteal reaction is observed. (B) CT demonstrates the sclerosis surrounding the lesion.
wjso.biomedcentral.com • CC-by-4.0
Uncommon
cause of lower back pain during childhood.. Note the central sclerotic dot inside the oval lucency.
www.eurorad.org • CC by-nc-sa-4.0
Pitfalls in
the diagnosis of common benign bone tumours in children. Osteoid osteoma of the left talar neck: Frontal (a) and lateral (b) X-rays of the left ankle: large round sclerotic fragment within an osteolytic cavity (arrows); no surrounding reactive osteosclerosis is identified. c Sagittal T1-weighted MRI: intense bone oedema surrounding the lesion. d Sagittal T2-weighted MRI: an intense inflammatory reaction is identified within the ankle joint. e CT, sagittal reconstruction: confirmation of the large nidus, entirely filled by the sclerotic fragment and with almost no surrounding osteosclerosis
insightsimaging.springeropen.com • Open Access
Pitfalls in
the diagnosis of common benign bone tumours in children. Osteoid osteoma of the antero-lateral tibial shaft: Frontal (a) and lateral (b) X-rays of the left tibia: osteosclerotic thickening of the antero-medial diaphyseal cortex. c Axial CT slice of the tibial shaft identifies a small lucent nidus (arrow) within the intense sclerotic cortical proliferation
insightsimaging.springeropen.com • Open Access
Osteoid
osteoma: the great mimicker. Osteoid osteoma mimicking anterior impingement. A 29-year-old male presenting with anterior ankle pain for 4 months. CR (a) showed mild sclerosis on the dorsal talar neck (arrow). T1 (b), T2 (c, d, e) and CT (f) showed a mineralized nidus (dotted arrows) with reactional synovitis (arrowhead), bone marrow edema (asterisk) and sclerosis
insightsimaging.springeropen.com • CC-by-4.0
Radiopaedia • CC-by-nc-sa 3.0 • de

Osteoid osteomas are benign bone-forming tumors that typically occur in children (particularly adolescents). They have a characteristic lucent nidus less than 1.5 or 2 cm and surrounding osteosclerotic reaction, which classically causes night pain that is relieved by the use of salicylate analgesia, e.g. aspirin.

Epidemiology

Osteoid osteomas are usually found in children, adolescents, and young adults, between the ages of 10 and 35 years .

They account for ~10% of all benign bone lesions and there is a male predilection (M:F 2-4:1) .

Clinical presentation

Classically patients present with nocturnal pain and is relieved by salicylates (e.g. aspirin).

When in the spine they are a classic cause of painful scoliosis, concave on the side of lesion. This typical presentation is seen in over 75% of cases .

Soft tissue swelling may occur (see case 4) and if close to a growth plate, accelerated growth may be evident , presumably related to hyperemia.

When the lesion is intracapsular, the presentation is more atypical, and more likely mimics inflammatory arthropathy or synovitis. Joint effusion is often present .

Pathology

An osteoid osteoma is composed of three concentric parts :

  • nidus, representing the neoplastic process
    • meshwork of dilated vessels, osteoblasts, osteoid, and woven bone
    • may have a central region of mineralization
  • fibrovascular rim
  • surrounding reactive sclerosis

    • The nidus releases prostaglandins (via the enzymes cyclo-oxygenase-1 and cyclo-oxygenase-2) which in turn result in pain .

    Location

    Most osteoid osteomas occur in long tubular bones of the limbs (especially the proximal femur), but any bone may be involved.

    • long bones of the limbs: ~65-80%
      • femur most common (especially neck of femur)
      • mid-tibial diaphysis common also
    • phalanges: ~20%
    • vertebrae: ~10%, predominantly posterior elements 
      • lumbar: 59%
      • cervical: 27%
      • thoracic: 12%
      • sacrum: 2%

    Furthermore, osteoid osteomas are usually cortical lesions but they can occur anywhere within the bone including medullary, subperiosteal (most commonly in the talus), and intracapsular .

    Radiographic features

    It is important to remember that the sclerosis is reactive and does not represent the lesion itself. The nidus is usually <2 cm in diameter, and is typically ovoid. It may have a central region of mineralization .

    Plain radiograph

    May be normal or may show a solid periosteal reaction with cortical thickening. The nidus is sometimes visible as a well-circumscribed lucent region, occasionally with a central sclerotic dot.

    CT

    CT is excellent at characterizing the lesion and is the modality of choice. It typically shows a focally lucent nidus within surrounding sclerotic reactive bone. A central sclerotic dot may also be seen.

    Nuclear medicine

    Skeletal scintigraphy will show typical focal uptake and at times will show a double density sign (also known as the less catchy hotter spot within hot area sign) which if present is highly specific and helpful in distinguishing it from osteomyelitis. The central focus showing intense uptake within a surrounding lower - but nonetheless increased - uptake rim.

    Ultrasound

    On ultrasound, focal cortical irregularity with adjacent hypoechoic synovitis may be present at the site of intra-articular lesions. The nidus can show hypoechogenicity with posterior acoustic enhancement. Ultrasound may be able to identify the nidus as a hypervascular nidus on Doppler examination .

    MRI

    Although MRI is sensitive, it is non-specific and is often unable to identify the nidus. The hyperemia and resultant bone marrow edema pattern may result in the scans being misinterpreted as representing aggressive pathology .

    The signal intensity of the nidus is variable on all sequences as is the degree of contrast enhancement .

    Treatment and prognosis

    The lesion is benign and treatment has traditionally been with surgical resection. Historically, this has, on occasion, been difficult because of the inherent inability to locate the nidus during surgery . However, percutaneous radiofrequency ablation under CT guidance is being used with increasing frequency .

    There is growing evidence, that osteoid osteoma naturally resolves spontaneously with time and can be treated conservatively with NSAIDs in certain groups of patients . The average time to resolution is 33 months.

    Differential diagnosis

    General imaging differential considerations include:

    Siehe auch:
    und weiter:
    Assoziationen und Differentialdiagnosen zu Osteoid-Osteom:
    Kompaktainsel
     
    Wikipedia • CC BY-SA 4.0
    Osteoidosteom
    des Femurs
    insightsimaging.springeropen.com • Open Access
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    der Fibula
    Wikipedia • CC BY-SA 3.0
    Osteoid-Osteom
    Schenkelhals
    Wikipedia • CC BY-SA 3.0
    Osteoid
    Osteoma Radio-frequency Ablation
    jmedicalcasereports.biomedcentral.com • CC-by-2.0
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    osteoma arterial enhancement
    Wikipedia • CC BY-SA 3.0
    kartilaginäre
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    Wikipedia • CC BY-SA 3.0
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    der Halswirbelsäule
    wjso.biomedcentral.com • CC-by-4.0