Eligible patients who give informed consent will be offered a NaF -PET/MRI scan

Chronic Recurrent Multifocal Osteomyelitis

PET/MRI scan after injection of 18F-labelled sodium fluoride

18F-NaF-PET/MRI

Rigshospitalet

Chronic Recurrent Multifocal Osteomyelitis - a Bacterial Cause?

Chronic Recurrent Multifocal Osteomyelitis - Search for a Bacterial Cause and Improving Imaging With PET/MRI

Compare no. of detected CRMO lesions on PET/MRI and standard diagnostic tests

Marie Øbro Fosbøl

Medical doctor

Rigshospitalet, Denmark

Region Sjælland

Pre-treatment imaging
Pre-treatment questionnaires and laboratory blood samples
Intervention (Thermal ablation of bone metastasis with MR-HIFU device Philips Sonalleve coupled with Philips Ingenia 3.0T)
Follow-up (imaging, questionnaires, laboratory)
Follow-up pain medication usage

Pre-treatment imaging
Pre-treatment questionnaires and laboratory blood samples
Intervention (Varian Truebeam Radiotherapy System)
Follow-up (imaging, questionnaires, laboratory)
Follow-up pain medication usage

Bone Metastases

Bone Neoplasm

Bone Cancer

Bone Lesion

Procedure is performed under proper analgesia (general or local anesthesia). The intervention can be performed in areas accessible with ultrasound with no critical structures (nerves, vasculature, bowels) in proximity. Limbs and pelvis are most usually accepted locations.
Patient is adjusted on top of the HIFU-transducer connected to MRI. First a MR-scan is performed and the treatment procedure is planned on consol. Then under MRI-guidance a point by point ablation of the target tumor is performed. During the treatment a real-time thermometry is obtained in order to avoid unwanted heating of related structures and to observe sufficient effect on treatment zone. After treatment MR-scan with gadolinium is performed to evaluate the size of ablated area.

Thermal ablation of bone metastasis with MR-HIFU device Philips Sonalleve coupled with Philips Ingenia 3.0T

Conventional radiotherapy focused on bone tumor. Pretreatment planning images acquired with computer tomography

Varian Truebeam Radiotherapy System

MR Imaging- Guided High Intensity Focused Ultrasound (HIFU) Therapy of Bone Metastases

Change in Visual analog scale pretreatment vs follow-up

Changes in tumor features pretreatment vs follow-up (signs of progression or regression)

Change in the use of strong opiate-based pain medication intake pretreatment vs follow-up

Change in SF-36 questionnaire pretreatment vs follow-up. SF36 is translated in finnish. It measures several variables related to quality of life ( eg mood, need of help)

Change in serum inflammatory cytokines pretreatment vs follow-up

Change in serum tumor-specific markers (eg. PSA for prostate cancer patients) pretreatment vs follow-up

Possible adverse effects found during treatment or in follow up will be collected and reported

Possible collaboration in the future with Karolinska Institute, Stockholm, during later stages of the study when performing randomized experiments. Data to be shared would be MRI- and CT-data, laboratory results and health-questionnaire results.

Turku University Hospital

Potential participants are recruited by oncologist from oncology outpatient clinic. Pretreatment imaging with computer tomography and magnetic resonance imaging is performed to evaluate whether the patient is eligible for HIFU-treatment. Those eligible will continue to the treatment and unsuitable participants will continue in the study as a control group receiving radiation therapy.
Participants in these groups will have follow-up MRI:s, ct:s, laboratory exams and fill in VAS (visual analog scale) and health questionnaire SF-36 regularly. Also intake of pain medication will be followed.

Ten males and two females with a mean age of 22.8 years were recruited. They all had bone tumor around the knee.

Bone Tumors

3D models of tumor-bearing bone segments were constructed by using computed tomography (CT) and magnetic resonance imaging (MRI). The 3D models were used to design the model of personalized titanium plates. The model of the plates was transferred into a numerical control machine for manufacturing the personalized titanium plates by 3D printing technology. The plates were then surgically implanted for reconstruction assistance following microwave-induced hyperthermia to remove the bone tumor. Implementation parameters and knee function were then evaluated.

Personalized titanium plate

The Application of Personalized Titanium Plate in the Bone Tumors Around the Knee

Personalized Titanium Plate Improves Clinical Outcome in Microwave Ablation of Bone Tumors Around the Knee

including flexion/extension, adduction/abduction, internal/external rotation, anteroposterior translation, distal/lateral translation, medial/lateral translation

bone neoplasms/feber

Chronic Recurrent Multifocal Osteomyelitis - a Bacterial Cause?

MR Imaging- Guided High Intensity Focused Ultrasound (HIFU) Therapy of Bone Metastases

The Application of Personalized Titanium Plate in the Bone Tumors Around the Knee

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