Ohio Teen Jumping Hurdles Days After HIFU Procedure

Stanford Children’s treats rare bone tumor without surgery, radiation, or a hospital stay

Ever since she was a little girl, Leah Reiter, 17, dreamed of becoming a track star. She ran track through elementary and middle school and made the varsity team in high school as a sprinter and hurdler.

Leah has her sights set on running track in college. Yet, before that could happen, life gave her one more hurdle to overcome. In the fall of her sophomore year, she started feeling pain in her left lower leg.

“The pain was there with every step I took, and it never went away. Even with medicines it just took the pain from a 10 to a 4,” says Leah.

The family thought it was a stress fracture, so they took Leah in for an x-ray. It didn’t show one. A few months went by with Leah living with the constant pain without complaint, until it was impossible to hide. “At an indoor state track meet that winter, she could hardly run, and we knew something was really wrong,” says Heidi, her mom.

Leah could feel a bump on her leg, and Heidi insisted that their local doctors give her a CT scan.

“That’s when we saw a mass that the doctors first thought was cancer,” Heidi says.

Luckily, it wasn’t cancer. It was an osteoid osteoma, a rare benign bone tumor that almost always presents in childhood. The main treatment for osteoid osteoma is radiofrequency (RF) ablation, a minimally invasive surgery that can mean limited activity for up to three months.

“I really didn’t want to be out for three months, track-wise. It would have set me back behind everyone else, right when I needed my best times,” Leah says.

Track times are scrutinized during a high schooler’s junior year. That’s when college recruiters look at your times and decide whether to offer you a spot on the team. Missing those crucial three months of training was not an option for Leah if she was to achieve her dream. “I promised her that we would find a treatment that wouldn’t interrupt her training,” Heidi says. That’s when Heidi learned about MRI-guided high-frequency focused ultrasound, or HIFU, and saw that Stanford Medicine Children’s Health offered it.

“We reached out to Stanford Children’s, and they immediately responded back. We sent her scans, and Avnesh S. Thakor, MD, PhD, with Interventional Radiology got back to us that same week,” Heidi says. 

HIFU as an alternative to surgery

HIFU can remove certain tumors without traditional surgery or radiation exposure. It focuses sound waves from an ultrasound on a single location to destroy just the tumor while minimizing damage to the surrounding tissue.

“HIFU focuses ultrasound to noninvasively generate heat or ice on a specific location in the body. It’s like using a magnifying glass to concentrate the sun’s rays on a single point. We destroy the tumor without needing to make an incision,” says Dr. Thakor. “When it’s done, patients look down at their leg and say, ‘What did you do?’ because there’s no sign of the treatment on the skin.”

HIFU’s list of benefits is long: It is noninvasive and nonsurgical, carries little risk, delivers zero ionizing radiation, requires no hospital stay, and has a quick recovery time. 

Stanford Medicine was an early adopter of HIFU in the United States, finding success with adults and older children, including a high school football player in 2019. Last year, Pejman Ghanouni, MD, PhD, who pioneered HIFU at Stanford, advocated for Stanford Children’s to acquire its own high-tech equipment with the help of Shreyas Vasanawala, MD, PhD, radiologist in chief, so it could perform HIFU for children conveniently on-site. Only a handful of large, national pediatric hospitals offer HIFU to children, and Stanford Children’s is the only one on the West Coast.

“Leah was the first patient we officially treated here at Stanford Children’s,” Dr. Thakor says. “When I met Leah and learned she was a track athlete, I really wanted to help her get back to running as quickly as possible.”

Historically, health insurance companies haven’t covered HIFU. Dr. Thakor and Dr. Ghanouni wanted to change that, so they partnered with Matthew Bucknor at the University of California San Francisco to perform a four-year randomized study to compare MRI-guided HIFU with CT-guided RF ablation. While very effective, RF ablation requires radiation as well as a small incision to drill a probe into the bone. With the scientific evidence in hand, getting insurance coverage is now easier. HIFU is used to treat other tumors beyond bone tumors. “It works best for superficial structures, like Leah’s tumor location on the surface of the bone,” Dr. Thakor says.

A successful HIFU surgery

Using an advanced high-energy ultrasound transducer, Dr. Thakor, along with Ali Bin Syed, MD, medical director of MRII at Stanford Children’s, and Rachelle Bitton, PhD, a Stanford physicist who specializes in HIFU, focused sound waves on Leah’s tumor, literally burning it up. Dr. Thakor describes HIFU as performing a series of passes to ablate the tissue, with each piece of tissue being the size of four or five rice grains. He has to carefully overlap each pass. “It’s not quite Star Trek’s waving of a wand, but it’s getting there,” he says. During the procedure, he used MRI-guided imaging in real time to ensure that neighboring tissue was not damaged and that he was hitting his precise targets.

“I can’t say enough about the care we received. Dr. Thakor is brilliant, and his bedside manner is so approachable and kind. The pediatric anesthesiologist was also fantastic, and so were the nurses and the whole staff,” Heidi says.

Leah woke up with little pain. “It was a different pain, and because the pain changed, I knew it was better,” she says. Unbelievably, she was discharged from the hospital that very same day.

Back to track within days

“I couldn’t believe it. I was back to jumping hurdles within 10 days,” Leah says. “It was such a relief to be free of the pain.”

Best of all, Leah has good track times to show college recruiters this fall.

Learn more about HIFU and other bone tumor treatments at Stanford Children’s >