Abstract
Osteoid osteoma is a painful, benign, osteoblastic lesion that occurs in younger patients and affects the extremities or the axial skeleton. While plain film findings may suggest the diagnosis, in complex anatomical regions such as the spine, pelvis, wrist and foot advanced imaging modalities are often required. A typical nidus surrounded by sclerosis or cortical thickening characterizes osteoid osteoma on plain radiography and CT. MR is the cross-sectional imaging modality of choice for most musculoskeletal disorders. Unfortunately, extensive accompanying bone marrow oedema, soft-tissue alterations, difficulty detecting the nidus, and lesion locations close to a joint (with reactive arthritis) may make a confident diagnosis of osteoid osteoma by MR imaging difficult. Hybrid imaging with bone-seeking tracers such as SPECT/CT with 99mTc-labelled bisphosphonates or PET/CT with 18F-labelled sodium fluoride (18F-NaF) combines high radionuclide uptake with morphological details and provides accurate diagnosis of osteoid osteoma and additional information for treatment planning. FDG is not the recommended PET tracer because osteoid osteoma is normally FDG-negative, although some osteoid osteomas may show increased FDG uptake. Osteoblastoma, Brodie’s abscess and stress fractures may mimic osteoid osteoma on imaging and clinical presentation. Once identified as the pain generator, destruction of the osteoid osteoma nidus by ablation or resection techniques usually leads to complete healing. Image-guided drill excision and radiofrequency ablation are widely used interventions. We review the presentation of osteoid osteoma across all imaging modalities, with special focus on hybrid imaging techniques.
Similar content being viewed by others
References
Bergstrand H. Uber eine eigenartige, wahrscheinlich bisher nicht beschriebene osteoblastiche krankheit in den langen knochen der hand und des fusses. Acta Radiol. 1930;11:596–613.
Jaffe H. Osteoid osteoma: a benign osteoblastic tumor composed of osteoid and atypical bone. Arch Surg. 1935;31:709–28.
Klein MH, Shankman S. Osteoid osteoma: radiologic and pathologic correlation. Skelet Radiol. 1992;21:23–31.
Loizaga JM, Calvo M, Lopez BF, Martinez TFJ, Perez VJ. Osteoblastoma and osteoid osteoma: clinical and morphological features of 162 cases. Pathol Res Pract. 1993;189:33–41.
Steiner GC. Ultrastructure of osteoid osteoma. Hum Pathol. 1976;7:309–25.
Kayser F, Resnick D, Haghighi P, Pereira E, Greenway G, Schweitzer M, et al. Evidence of the subperiosteal origin of osteoid osteomas in tubular bones: analysis by CT and MR imaging. AJR Am J Roentgenol. 1998;170:609–14.
Chai JW, Hong SH, Choi JY, Koh YH, Lee JW, Choi JA, et al. Radiologic diagnosis of osteoid osteoma: from simple to challenging findings. Radiographics. 2010;30(3):737–49. https://doi.org/10.1148/rg.303095120.
Iyer RS, Chapman T, Chew FS. Pediatric bone imaging: diagnostic imaging of osteoid osteoma. AJR Am J Roentgenol. 2012;198(5):1039–52. https://doi.org/10.2214/AJR.10.7313.
Kransdorf MJ, Stull MA, Gilkey FW, Moser RP Jr. Osteoid osteoma. Radiographics. 1991;11(4):671–96. https://doi.org/10.1148/radiographics.11.4.1887121.
Kneisl JS, Simon MA. Medical management compared with operative treatment for osteoid-osteoma. J Bone Joint Surg Am. 1992;74:179–85.
Laurence N, Epelman M, Markowitz RI, Jaimes C, Jaramillo D, Chauvin NA. Osteoid osteomas: a pain in the night diagnosis. Pediatr Radiol. 2012;42(12):1490–501. https://doi.org/10.1007/s00247-012-2495-y.
Lee EH, Shafi M, Hui JH. Osteoid osteoma: a current review. J Pediatr Orthop. 2006;26(5):695–700. https://doi.org/10.1097/01.bpo.0000233807.80046.7c.
Swee RG, McLeod RA, Beabout JW. Osteoid osteoma. Detection, diagnosis, and localization. Radiology. 1979;130:117–23.
Ebrahim FS, Jacobson JA, Lin J, Housner JA, Hayes CW, Resnick D. Intraarticular osteoid osteoma: sonographic findings in three patients with radiographic, CT, and MR imaging correlation. AJR Am J Roentgenol. 2001;177:1391–5.
Gil S, Marco SF, Arenas J, Irurzun J, Agullo T, Alonso S, et al. Doppler duplex color localization of osteoid osteomas. Skelet Radiol. 1999;28:107–10.
Helms CA, Hattner RS, Vogler JB. Osteoid osteoma: radionuclide diagnosis. Radiology. 1984;151:779–84.
Lindbom A, Lindvall N, Soderberg G, Spjut H. Angiography in osteoid osteoma. Acta Radiol. 1960;54:327–33.
von Kalle T, Langendorfer M, Fernandez FF, Winkler P. Combined dynamic contrast-enhancement and serial 3D-subtraction analysis in magnetic resonance imaging of osteoid osteomas. Eur Radiol. 2009;19(10):2508–17. https://doi.org/10.1007/s00330-009-1430-6.
Greco F, Tamburrelli F, Ciabattoni G. Prostaglandins in osteoid osteoma. Int Orthop. 1991;15:35–7.
Mungo DV, Zhang X, O’Keefe RJ. COX-1 and COX-2 expression in osteoid osteomas. J Orthop Res. 2002;20:159–62.
Gautschi M, Strobel K, Schoniger R, Pfeiffer D, Schmid L. A special case of monoarthritis of the elbow. Z Rheumatol. 2017;76(7):636–9. https://doi.org/10.1007/s00393-017-0359-4.
Basu S, Basu P, Dowell J. Painless osteoid osteoma in a metacarpal. J Hand Surg Br. 1999;24:133–4.
Ekmekci P, Bostanci S, Erdogan N, Akcaboy B, Guergey E. A painless subungual osteoid osteoma. Dermatol Surg. 2001;27:764–5.
Papathanassiou ZG, Megas P, Petsas T, Papachristou DJ, Nilas J, Siablis D. Osteoid osteoma: diagnosis and treatment. Orthopedics. 2008;31(11):1118.
Edeiken J, DePalma AF, Hodes PJ. Osteoid osteoma. (Roentgenographic emphasis). Clin Orthop Relat Res. 1966;49:201–6.
Graham GN, Browne H. Primary bony tumors of the pediatric spine. Yale J Biol Med. 2001;74(1):1–8.
Healey JH, Ghelman B. Osteoid osteoma and osteoblastoma. Current concepts and recent advances. Clin Orthop Relat Res. 1986;204:76–85.
Ghanem I. The management of osteoid osteoma: updates and controversies. Curr Opin Pediatr. 2006;18(1):36–41. https://doi.org/10.1097/01.mop.0000193277.47119.15.
Gamba JL, Martinez S, Apple J, Harrelson JM, Nunley JA. Computed tomography of axial skeletal osteoid osteomas. AJR Am J Roentgenol. 1984;142(4):769–72. https://doi.org/10.2214/ajr.142.4.769.
Harish S, Saifuddin A. Imaging features of spinal osteoid osteoma with emphasis on MRI findings. Eur Radiol. 2005;15(12):2396–403. https://doi.org/10.1007/s00330-005-2816-8.
Jordan RW, Koc T, Chapman AW, Taylor HP. Osteoid osteoma of the foot and ankle – a systematic review. Foot Ankle Surg. 2015;21(4):228–34. https://doi.org/10.1016/j.fas.2015.04.005.
Athwal GS, Pichora DR, Ellis RE, Rudan JF. A computer-assisted guidance technique for the localization and excision of osteoid osteoma. Orthopedics. 2004;27(2):195–7.
Liu PT, Kujak JL, Roberts CC, de Chadarevian JP. The vascular groove sign: a new CT finding associated with osteoid osteomas. AJR Am J Roentgenol. 2011;196(1):168–73. https://doi.org/10.2214/AJR.10.4534.
Levine E, Neff JR. Dynamic computed tomography scanning of benign bone lesions: preliminary results. Skelet Radiol. 1983;9(4):238–45.
McGrath BE, Bush CH, Nelson TE, Scarborough MT. Evaluation of suspected osteoid osteoma. Clin Orthop Relat Res. 1996;327:247–52.
Assoun J, Richardi G, Railhac JJ, Baunin C, Fajadet P, Giron J, et al. Osteoid osteoma: MR imaging versus CT. Radiology. 1994;191(1):217–23. https://doi.org/10.1148/radiology.191.1.8134575.
Davies M, Cassar-Pullicino VN, Davies AM, McCall IW, Tyrrell PN. The diagnostic accuracy of MR imaging in osteoid osteoma. Skelet Radiol. 2002;31(10):559–69. https://doi.org/10.1007/s00256-002-0546-4.
Zanetti M, Eberhard SM, Exner GU, von Hochstetter A, Hodler J. Magnetic resonance tomography in osteoid osteoma: more confusion than benefit?. Praxis (Bern 1994). 1997;86(11):432–6.
Liu PT, Chivers FS, Roberts CC, Schultz CJ, Beauchamp CP. Imaging of osteoid osteoma with dynamic gadolinium-enhanced MR imaging. Radiology. 2003;227(3):691–700. https://doi.org/10.1148/radiol.2273020111.
Wells RG, Miller JH, Sty JR. Scintigraphic patterns in osteoid osteoma and spondylolysis. Clin Nucl Med. 1987;12(1):39–44.
Park JH, Pahk K, Kim S, Lee SH, Song SH, Choe JG. Radionuclide imaging in the diagnosis of osteoid osteoma. Oncol Lett. 2015;10(2):1131–4. https://doi.org/10.3892/ol.2015.3258.
Helms CA. Osteoid osteoma. The double density sign. Clin Orthop Relat Res. 1987;222:167–73.
Roach PJ, Connolly LP, Zurakowski D, Treves ST. Osteoid osteoma: comparative utility of high-resolution planar and pinhole magnification scintigraphy. Pediatr Radiol. 1996;26(3):222–5.
Banzo I, Montero A, Uriarte I, Vallina NK, Hernandez A, Guede C, et al. Localization by bone SPET of osteoid osteoma in the vertebral lamina. Rev Esp Med Nucl. 1999;18(1):47–9.
Ryan PJ, Fogelman I. Bone SPECT in osteoid osteoma of the vertebral lamina. Clin Nucl Med. 1994;19(2):144–5.
Hasegawa BH, Wong KH, Iwata K, Barber WC, Hwang AB, Sakdinawat AE, et al. Dual-modality imaging of cancer with SPECT/CT. Technol Cancer Res Treat. 2002;1(6):449–58. https://doi.org/10.1177/153303460200100605.
Mariani G, Bruselli L, Kuwert T, Kim EE, Flotats A, Israel O, et al. A review on the clinical uses of SPECT/CT. Eur J Nucl Med Mol Imaging. 2010;37(10):1959–85. https://doi.org/10.1007/s00259-010-1390-8.
Farid K, El-Deeb G, Caillat Vigneron N. SPECT-CT improves scintigraphic accuracy of osteoid osteoma diagnosis. Clin Nucl Med. 2010;35(3):170–1. https://doi.org/10.1097/RLU.0b013e3181cc648f.
Sharma P, Mukherjee A, Karunanithi S, Nadarajah J, Gamanagatti S, Khan SA, et al. 99mTc-methylene diphosphonate SPECT/CT as the one-stop imaging modality for the diagnosis of osteoid osteoma. Nucl Med Commun. 2014;35(8):876–83. https://doi.org/10.1097/MNM.0000000000000134.
Squier SB, Lewis JI, Accurso JM, Jain MK. (99m)Tc-methylene diphosphonate single-photon emission computed tomography/computed tomography improves the diagnostic accuracy of osteoid osteoma. Indian J Nucl Med. 2016;31(4):298–300. https://doi.org/10.4103/0972-3919.187459.
Beheshti M, Mottaghy FM, Payche F, Behrendt FFF, Van den Wyngaert T, Fogelman I, et al. (18)F-NaF PET/CT: EANM procedure guidelines for bone imaging. Eur J Nucl Med Mol Imaging. 2015;42(11):1767–77. https://doi.org/10.1007/s00259-015-3138-y.
Segall G, Delbeke D, Stabin MG, Even-Sapir E, Fair J, Sajdak R, et al. SNM practice guideline for sodium 18F-fluoride PET/CT bone scans 1.0. J Nucl Med. 2010;51(11):1813–20. https://doi.org/10.2967/jnumed.110.082263.
Even-Sapir E, Metser U, Mishani E, Lievshitz G, Lerman H, Leibovitch I. The detection of bone metastases in patients with high-risk prostate cancer: 99mTc-MDP planar bone scintigraphy, single- and multi-field-of-view SPECT, 18F-fluoride PET, and 18F-fluoride PET/CT. J Nucl Med. 2006;47(2):287–97.
Shen CT, Qiu ZL, Han TT, Luo QY. Performance of 18F-fluoride PET or PET/CT for the detection of bone metastases: a meta-analysis. Clin Nucl Med. 2015;40(2):103–10. https://doi.org/10.1097/RLU.0000000000000592.
Strobel K, Fischer DR, Tamborrini G, Kyburz D, Stumpe KD, Hesselmann RG, et al. 18F-fluoride PET/CT for detection of sacroiliitis in ankylosing spondylitis. Eur J Nucl Med Mol Imaging. 2010;37(9):1760–5. https://doi.org/10.1007/s00259-010-1464-7.
Fischer DR, Maquieira GJ, Espinosa N, Zanetti M, Hesselmann R, Johayem A, et al. Therapeutic impact of [(18)F]fluoride positron-emission tomography/computed tomography on patients with unclear foot pain. Skelet Radiol. 2010;39(10):987–97. https://doi.org/10.1007/s00256-010-0875-7.
Drubach LA, Johnston PR, Newton AW, Perez-Rossello JM, Grant FD, Kleinman PK. Skeletal trauma in child abuse: detection with 18F-NaF PET. Radiology. 2010;255(1):173–81. https://doi.org/10.1148/radiol.09091368.
Dasa V, Adbel-Nabi H, Anders MJ, Mihalko WM. F-18 fluoride positron emission tomography of the hip for osteonecrosis. Clin Orthop Relat Res. 2008;466(5):1081–6. https://doi.org/10.1007/s11999-008-0219-2.
Dua SG, Purandare NC, Shah S, Rangarajan V. F-18 fluoride PET/CT in the detection of radiation-induced pelvic insufficiency fractures. Clin Nucl Med. 2011;36(10):e146–9. https://doi.org/10.1097/RLU.0b013e31821a293b.
Brenner W, Vernon C, Conrad EU, Eary JF. Assessment of the metabolic activity of bone grafts with (18)F-fluoride PET. Eur J Nucl Med Mol Imaging. 2004;31(9):1291–8. https://doi.org/10.1007/s00259-004-1568-z.
Grant FD. (18)F-fluoride PET and PET/CT in children and young adults. PET Clin. 2014;9(3):287–97. https://doi.org/10.1016/j.cpet.2014.03.004.
Strobel K, Vali R. (18)F NaF PET/CT versus conventional bone scanning in the assessment of benign bone disease. PET Clin. 2012;7(3):249–61. https://doi.org/10.1016/j.cpet.2012.04.007.
Even-Sapir E, Mishani E, Flusser G, Metser U. 18F-fluoride positron emission tomography and positron emission tomography/computed tomography. Semin Nucl Med. 2007;37(6):462–9. https://doi.org/10.1053/j.semnuclmed.2007.07.002.
Lim CH, Park YH, Lee SY, Chung SK. F-18 FDG uptake in the nidus of an osteoid osteoma. Clin Nucl Med. 2007;32(8):628–30. https://doi.org/10.1097/RLU.0b013e3180a1acf3.
Imperiale A, Moser T, Ben-Sellem D, Mertz L, Gangi A, Constantinesco A. Osteoblastoma and osteoid osteoma: morphofunctional characterization by MRI and dynamic F-18 FDG PET/CT before and after radiofrequency ablation. Clin Nucl Med. 2009;34(3):184–8. https://doi.org/10.1097/RLU.0b013e3181966de6.
Aoki J, Watanabe H, Shinozaki T, Takagishi K, Ishijima H, Oya N, et al. FDG PET of primary benign and malignant bone tumors: standardized uptake value in 52 lesions. Radiology. 2001;219(3):774–7. https://doi.org/10.1148/radiology.219.3.r01ma08774.
Strobel K, Hany TF, Exner GU. PET/CT of a Brodie abscess. Clin Nucl Med. 2006;31(4):210. https://doi.org/10.1097/01.rlu.0000204125.79919.44.
Hudson TM, Hawkins IF Jr. Radiological evaluation of chondroblastoma. Radiology. 1981;139(1):1–10. https://doi.org/10.1148/radiology.139.1.7208908.
Atesok KI, Alman BA, Schemitsch EH, Peyser A, Mankin H. Osteoid osteoma and osteoblastoma. J Am Acad Orthop Surg. 2011;19(11):678–89.
Moberg E. The natural course of osteoid osteoma. J Bone Joint Surg Am. 1951;33 A(1):166–70.
Goto T, Shinoda Y, Okuma T, Ogura K, Tsuda Y, Yamakawa K, et al. Administration of nonsteroidal anti-inflammatory drugs accelerates spontaneous healing of osteoid osteoma. Arch Orthop Trauma Surg. 2011;131(5):619–25. https://doi.org/10.1007/s00402-010-1179-z.
Rosenthal DI, Hornicek FJ, Torriani M, Gebhardt MC, Mankin HJ. Osteoid osteoma: percutaneous treatment with radiofrequency energy. Radiology. 2003;229(1):171–5. https://doi.org/10.1148/radiol.2291021053.
Lindner NJ, Ozaki T, Roedl R, Gosheger G, Winkelmann W, Wortler K. Percutaneous radiofrequency ablation in osteoid osteoma. J Bone Joint Surg Br. 2001;83(3):391–6.
Rosenthal DI, Springfield DS, Gebhardt MC, Rosenberg AE, Mankin HJ. Osteoid osteoma: percutaneous radio-frequency ablation. Radiology. 1995;197(2):451–4. https://doi.org/10.1148/radiology.197.2.7480692.
Sans N, Galy-Fourcade D, Assoun J, Jarlaud T, Chiavassa H, Bonnevialle P, et al. Osteoid osteoma: CT-guided percutaneous resection and follow-up in 38 patients. Radiology. 1999;212(3):687–92. https://doi.org/10.1148/radiology.212.3.r99se06687.
Woertler K, Vestring T, Boettner F, Winkelmann W, Heindel W, Lindner N. Osteoid osteoma: CT-guided percutaneous radiofrequency ablation and follow-up in 47 patients. J Vasc Interv Radiol. 2001;12(6):717–22.
Kostrzewa M, Diezler P, Michaely H, Rathmann N, Attenberger UI, Schoenberg SO, et al. Microwave ablation of osteoid osteomas using dynamic MR imaging for early treatment assessment: preliminary experience. J Vasc Interv Radiol. 2014;25(1):106–11. https://doi.org/10.1016/j.jvir.2013.09.009.
Napoli A, Bazzocchi A, Scipione R, Anzidei M, Saba L, Ghanouni P, et al. Noninvasive therapy for osteoid osteoma: a prospective developmental study with MR imaging-guided high-intensity focused ultrasound. Radiology. 2017;285(1):186–96. https://doi.org/10.1148/radiol.2017162680.
Acknowledgments
Figure 12: Image courtesy of Dr. Alessio Imperiale, Nuclear Medicine, University Hospital Strasbourg, France.
Figure 13: Image courtesy of Dr. Joachim Müller, Nuclear Medicine, Cantonal Hospital St. Gallen, Switzerland.
Figures 7 and 9: Image design courtesy of Lutz Lehmann, Luzerner Kantonsspital, Luzern, Switzerland.
Author information
Authors and Affiliations
Contributions
All authors contributed in a significant way to the content and revision of this manuscript. All authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Conflicts of interest
None.
Ethical approval and consent to participate
Not applicable.
Consent to publication
Not applicable.
Rights and permissions
About this article
Cite this article
Bhure, U., Roos, J.E. & Strobel, K. Osteoid osteoma: multimodality imaging with focus on hybrid imaging. Eur J Nucl Med Mol Imaging 46, 1019–1036 (2019). https://doi.org/10.1007/s00259-018-4181-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00259-018-4181-2