Comparison of Imaging Changes and Pain Responses in Patients with Intra- or Extraosseous Bone Metastases Treated Palliatively with Magnetic Resonance-Guided High-Intensity-Focused Ultrasound

J Vasc Interv Radiol. 2019 Sep;30(9):1351-1360.e1. doi: 10.1016/j.jvir.2019.02.019. Epub 2019 May 14.


Purpose: This study compared changes in imaging and in pain relief between patients with intraosseous, as opposed to extraosseous bone metastases. Both groups were treated palliatively with magnetic resonance-guided high-intensity-focused ultrasound (MRgHIFU).

Materials and methods: A total of 21 patients were treated prospectively with MRgHIFU at 3 centers. Intraprocedural thermal changes measured using proton resonance frequency shift (PRFS) thermometry and gadolinium-enhanced T1-weighted (Gd-T1W) image appearances after treatment were compared for intra- and extraosseous metastases. Pain scores and use of analgesic therapy documented before and up to 90 days after treatment were used to classify responses and were compared between the intra- and extraosseous groups. Gd-T1W changes were compared between responders and nonresponders in each group.

Results: Thermal dose volumes were significantly larger in the extraosseous group (P = 0.039). Tumor diameter did not change after treatment in either group. At day 30, Gd-T1W images showed focal nonenhancement in 7 of 9 patients with intraosseous tumors; in patients with extraosseous tumors, changes were heterogeneous. Cohort reductions in worst-pain scores were seen for both groups, but differences from baseline at days 14, 30, 60, and 90 were only significant for the intraosseous group (P = 0.027, P = 0.013, P = 0.012, and P = 0.027, respectively). By day 30, 67% of patients (6 of 9) with intraosseous tumors were classified as responders, and the rate was 33% (4 of 12) for patients with extraosseous tumors. In neither group was pain response indicated by nonenhancement on Gd-T1W.

Conclusions: Intraosseous tumors showed focal nonenhancement by day 30, and patients had better pain response to MRgHIFU than those with extraosseous tumors. In this small cohort, post-treatment imaging was not informative of treatment efficacy.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • Analgesics / therapeutic use
  • Bone Neoplasms / complications
  • Bone Neoplasms / diagnostic imaging
  • Bone Neoplasms / secondary
  • Bone Neoplasms / therapy*
  • Europe
  • Extracorporeal Shockwave Therapy* / adverse effects
  • Female
  • Humans
  • Magnetic Resonance Imaging, Interventional*
  • Male
  • Middle Aged
  • Musculoskeletal Pain / diagnosis
  • Musculoskeletal Pain / drug therapy
  • Musculoskeletal Pain / etiology*
  • Pain Measurement
  • Palliative Care*
  • Predictive Value of Tests
  • Prospective Studies
  • Seoul
  • Time Factors
  • Treatment Outcome


  • Analgesics