Mechanism of intramedullary high intensity area on T2-weighted magnetic resonance imaging in osteoid osteoma: a possible role of COX-2 expression.

To study the mechanism and pathophysiology of the development of intramedullary high intensity areas on T2-weighted magnetic resonance images (MRI) in cases of osteoid osteoma, we examined the expression of cyclooxygenase-2 (COX-2) in the nidus and surrounding bone tissues. In all six cases showing a marked intramedullary high intensity area adjacent to the nidus before surgery, neoplastic osteoblasts inside the nidus showed strong and diffuse COX-2 immunoreactivity. On the other hand, the osteoblasts rimming the surrounding reactive bone were COX-2 negative. In two cases examined by reverse transcription-polymerase chain reaction (RT-PCR), COX-2 mRNA was detected in abundance in the nidus. Histologically, vascular dilatation together with intramedullary edema was observed in all cases, which was probably reflected as a high intensity area on T2-weighted MRI. From our study, a high level of COX-2 expression in neoplastic osteoblasts in the nidus of osteoid osteomas may cause the secondary changes depicted by MRI.