Weakening or structural strengthening? An evaluation of bone density after mrgfus ablation for treatment of benign bone lesions

Previous studies suggest that interventional ablative procedures on bone lesions may weaken the bone, especially when performed through the needle approach. Our purpose was to evaluate, through Computed Tomography (CT), the effects of Magnetic Resonance guided Focused Ultrasound Surgery (MRgFUS) ablation on painful osteoid osteomas and osteoblastomas in terms of bone density and morphological changes. We retrospectively evaluated patients treated at our institution with MRgFUS for superficial, painful osteoid osteoma or osteoblastoma during the last 9 years. Inclusion criteria were procedural and clinical success, as well as the availability of pre‐ and postprocedural CT examinations. Imaging features assessed were perilesional/nidus density changes and the occurrence of pathological fractures during the follow‐up period. Our study population included 31 osteoid osteomas and 5 intra‐articular osteoblastomas in 36 treated patients. We found an increased bone density of the lesions when pre and post‐treatment CT‐ values were compared: these differences were statistically significant, and this finding is consistent with significant bone densification at the post‐treatment imaging follow‐up. No pathological fractures were observed after ablation during the follow‐up. MRgFUS can be considered to be the treatment of choice for benign superficial bone lesions, thanks to its minimal invasiveness, excellent effectiveness, and safety. Pathological fractures, reported in literature as a rare event using needle ablation, never occurred in our MRgFUS treatment series.