title: Treatment of aneurysmal bone cysts by percutaneous CT-guided injection of calcitonin and steroid.
abstract: OBJECTIVE
  To determine the efficacy and safety of percutaneous calcitonin and steroid injection in the treatment of aneurysmal bone cysts (ABCs).
  
  
  METHODS
  Our study was IRB-approved and HIPAA-compliant. We reviewed pre- and post-procedural imaging studies and medical records of all CT-guided percutaneous injections of ABCs with calcitonin and steroid performed at our institution between 2003 and 2015.
  
  
  RESULTS
  Treatment success based on imaging was categorized as substantial (51-100 %), partial (1-50 %), or none (0 %) by comparing radiographs of the lesion before and after treatment. Our study group comprised 9 patients (7 female, 2 male; mean age 19 ± 5 (range 12-25) years). ABCs were located in the pubis (n = 3), femur (n = 2), and humerus/scapula/ilium/sacrum (n = 1 for each). One patient did not have any clinical or imaging follow-up. For the other 8 patients, clinical and imaging follow-up ranged from 1 to 93 months (mean 16 ± 29 months). One patient had two injections, and 1 patient had three injections. Six out of eight patients (75 %) had complete symptomatic relief and 2 patients (25 %) had partial symptomatic relief after initial injection. Imaging follow-up revealed substantial imaging response in 4 out of 8 patients (50 %). There was a partial imaging response in 2 patients (25 %) and no imaging response in 2 out of 8 patients (25 %), and all 4 of these patients had local recurrence. There were no complications.
  
  
  CONCLUSIONS
  Percutaneous CT-guided injection of ABCs with calcitonin and steroid is a safe and effective treatment. Lack of imaging response may necessitate more aggressive treatment to minimize local recurrence.
authors.affiliation: Department of Radiology Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital, 55 Fruit Street Yawkey 6E, Boston, MA, 02114, USA. cychang@mgh.harvard.edu.
authors.forename: Connie Y
authors.initials: CY
authors.lastname: Chang
authors.affiliation: Department of Radiology Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital, 55 Fruit Street Yawkey 6E, Boston, MA, 02114, USA.
authors.forename: Susan V
authors.initials: SV
authors.lastname: Kattapuram
authors.affiliation: Department of Radiology Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital, 55 Fruit Street Yawkey 6E, Boston, MA, 02114, USA.
authors.forename: Ambrose J
authors.initials: AJ
authors.lastname: Huang
authors.affiliation: Department of Radiology Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital, 55 Fruit Street Yawkey 6E, Boston, MA, 02114, USA.
authors.forename: F Joseph
authors.initials: FJ
authors.lastname: Simeone
authors.affiliation: Department of Radiology Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital, 55 Fruit Street Yawkey 6E, Boston, MA, 02114, USA.
authors.forename: Martin
authors.initials: M
authors.lastname: Torriani
authors.affiliation: Department of Radiology Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital, 55 Fruit Street Yawkey 6E, Boston, MA, 02114, USA.
authors.forename: Miriam A
authors.initials: MA
authors.lastname: Bredella
mesh_terms: D000293:Adolescent; D000328:Adult; D017824:Bone Cysts, Aneurysmal / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D050071:Bone Density Conservation Agents / Q000008:administration & dosage*; D002116:Calcitonin / Q000008:administration & dosage*; D002648:Child; D005260:Female; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D015641:Radiography, Interventional; D013256:Steroids / Q000008:administration & dosage*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D050071:Bone Density Conservation Agents; D013256:Steroids; D002116:Calcitonin
keywords: ABC; Aneurysmal bone cyst; CT; Calcitonin; Percutaneous; Sclerotherapy; Steroid