Imaging-derived risk score predicts pain recurrence in osteoid osteoma patients undergoing radiofrequency ablation.
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BACKGROUND: Pain recurrence following regular radiofrequency ablation (RFA) in osteoid osteoma (OO) remains incompletely understood, yet impacts quality of life. PURPOSE: To detect predictive imaging parameters in OO with symptomatic recurrence. MATERIAL AND METHODS: This retrospective, monocentric study included 122 OO patients [median age 19 (16; 27) years, male 78%] January 2010 to May 2024, which underwent T1-weighted dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) (3T) before CT-guided RFA. Pain recurrence was defined as visual analogue scale increase >4/10 occurring >2 weeks post-intervention (22 (18%) patients). Nidus was categorized intra-/extracortical. DCE-MRI relative/maximum (relative) enhancement (M(R)E) (%), time to peak (TTP) (s), wash-in/out rate (s-1), brevity of enhancement (s) were compared by Wilcoxon rank-sum test. Hazard ratios (HR), multivariate cox proportional hazard regression, receiver operating characteristics and Bayesian were performed. RESULTS: Extracortical nidus occurred more frequently in patients with recurrence (14%) compared to intracortical nidus (5%, p < 0.001). Patients with recurrence had lower MRE [median, 327.2 (IQR, 227.5-393.6)% vs 386.1 (261, 511.6)%; p = 0.038], higher TTP [47.1 (34.5-59.5) vs 32.3 (24.7-46.7); p = 0.002], lower wash-in rate [38.9 (0-107.5) vs. 83.7(30.5-159.7); p = 0.028]. ME [HR 0.2 (95% CI: 0.06, 0.04); p < 0.001], MRE [HR 0.3 (0.1,1); p = 0.042], TTP [HR 6 (1.4, 25.4); p = 0.016], wash-in rate [HR 0.1(0.02, 0.8); p = 0.03] were predictors of recurrence. Extracortical nidus [HR 6.5 (2.1, 19.7); p < 0.001] was predictive. In extracortical nidus-subgroup recurrence probability ≥55% occurred with TTP >40 s, MRE <300%. CONCLUSION: Imaging-based risk stratification enables personalized treatment approaches for osteoid osteoma patients, who may benefit from alternative ablation protocols such as extended ablation time, higher temperatures.