Society of Skeletal Radiology– white paper. Guidelines for the diagnostic management of incidental solitary bone lesions on CT and MRI in adults: bone reporting and data system (Bone-RADS) (original) (raw)
Related papers
Skeletal Radiology, 1988
Following an abnormal radiograph, an initial 34 patients had both computed tomography (CT) and magnetic resonance (MR) to further characterize and stage a solitary tumor. This experience determined the choice between CT and MR in evaluating the next 55 solitary tumors. The choice of examination depends on the radiologist's ability to characterize the lesion from the radiograph as to its morphology, matrix, and probable histologic nature. The anatomic location, in turn, frequently influences the ability to characterize the lesion. Lesions in long bones can almost always be successfully characterized by radiography and, in these instances, only the MR examination is required to stage the tumor. Radiographic characterization of tumors in flat bones such as the scapula, certain portions of ribs, vertebrae, and pelvis is often difficult or incomplete. In these cases, CT is the preferred initial examination, and if further staging is required to establish the relationship of the tumor to soft tissues or neurovascular structures, the MR examination is done. Because of MR's superiority in staging the tumor and CT's superiority in characterizing the lesion, the initial choice between the two examinations should depend on the radiologist's ability to characterize the lesion from the radiograph. When radiographic depiction of tumor permits assessment of its morphology, matrix and probable histologic nature, (characterization) MR ought to be the next examination solely for staging purposes. It is the anatomic location of the tumor and the radiologist's ability to characterize it that ought to govern the choice of the next examination. Surgical and histopathological findings were known in all patients in this study.
Solitary bone lesions: which ones to worry about?
Cancer Imaging, 2012
The question is not classic: which signs suggest a possible malignancy when faced with a solitary bone lesion? Usually radiologists try to identify the leave me alone lesions, for which nothing is needed. Here we consider the suspicious lesions. Clinical and radiological indicators are proposed, leading to a probability. Nowadays, a biopsy is nevertheless always requested before treating a malignant lesion, even if suspicion is very high. But histology should integrate with the radiological signs.
Follow-up of Occult Bone Lesions Detected at MR Imaging: Systematic Review 1
Radiology, 2006
To perform a systematic review of the literature regarding the natural course of posttraumatic occult bone lesions (often referred to as bone bruises) detected at magnetic resonance (MR) imaging. Materials and Methods: A systematic review of the literature was performed by searching the MEDLINE database (from January 1966 to February 2003) with the keywords bone bruise, trauma, follow-up, and MRI. Keywords were linked by using the Boolean operator AND. Studies were included if all of the following criteria were fulfilled: patients sustained trauma, MR imaging was used as a diagnostic method, results of clinical or MR imaging follow-up were available, and study was written in English, Dutch, German, French, Spanish, Italian, Swedish, Danish, or Norwegian. The quality of each study was assessed by using a standardized criteria set, and statistics were estimated to rate the level of agreement between the two reviewers. Results were compared with regard to study design and quality scores. Results: The MEDLINE search identified 266 articles, 13 of which met the inclusion criteria. The quality of the included studies was moderate. The two reviewers initially agreed on 179 quality items (ϭ 0.84). The study population was generally small, and follow-up periods ranged from 1 to 73 months. Four different classification systems were used, and in two studies bone bruise was not specified. Study results suggest a generally good clinical prognosis of bone bruises. Normalization of MR imaging appearance is possible and is most often encountered after the occurrence of reticular lesions. Cartilage loss at follow-up is often found in cases of initial cartilage damage (impaction or osteochondral fracture). Conclusion: In general, a healing response was often encountered after sustained posttraumatic occult bone lesions. The initial MR imaging appearance appears to have prognostic value.
Journal of Medical Imaging and Radiation Sciences, 2018
Background: The conventional radiologic features that differentiate benign from malignant bone lesions were originally described using radiography (x-ray [XR]). When evaluating sectional imaging studies such as magnetic resonance imaging (MRI) and computed tomography (CT), one may apply these principles to identify malignant bone lesions. The aim of this study was to evaluate the performances of these radiographic features for detecting malignity when applied to CT and MRI.
Study of clinical, radiological, and histopathological features of bone lesions- A two-year study
Medico Research Chronicles, 2021
Background: A pathological bone lesion can present in any form of inflammatory to neoplastic conditions and they pose a definite diagnostic challenge. The aim of the present research was to study the incidence, age of presentation, and site of bone lesions, overview the clinical, imaging, and pathologic findings, and also compare radiological and histological findings. Methods: This study was conducted in 30 cases of bone lesions, who presented to a tertiary care hospital from May 2010 to September 2012. Clinical examination was done initially, followed by radiological imaging (X-ray, CT & MRI). Based on imaging, the decision of biopsy was taken for final diagnosis. Histopathological examination was done on Hematoxylin and Eosin stained slides. Results: Out of 30 cases, 14(46.66%) cases were benign, 14(46.66%) were malignant tumors and 2(6.66%) were non-neoplastic lesions. Osteochondroma (35.71%) was the most common benign bone tumor and multiple myeloma (28.57%) was the commonest malignant tumor while non-neoplastic lesions were avascular necrosis of hip & chronic osteomyelitis. The primary bone tumors occurred mostly in 0-50 years, while half cases of multiple myeloma and metastatic tumors were seen 1-2 decades higher. 85.71% of benign tumors occurred in males while malignant tumors showed equal sex incidence. All nonneoplastic cases occurred in males. The femur was most commonly involved long bone while the pelvis was the most commonly involved flat bone. Radiological diagnosis was consistent with histopathological diagnosis in 80% of cases. Conclusion: Age, sex, and site are important clinical parameters. Radiology and imaging investigation is an essential Corresponding author Dr. Naveen Chawla * step in the diagnosis, prior to histopathological study. Clinical, imaging and histopathology thus remains the key for diagnosing bone lesions; especially so in bone tumors.
2021
Background: Characterization of solitary osseous lesions on planar bone scintigraphy (PBS) is challenging. In this pilot study, we aimed to explore the diagnostic performance of 99mTc-MDP bone scintigraphy using SPECT/CT in comparison to magnetic resonance imaging including diffusion-weighted imaging (MR-DWI) in patients with solitary indeterminate osseous lesions detected on PBS. Methods: This pilot study prospectively recruited 46 cancer patients who underwent PBS, with a finding of a solitary osseous lesion that was deemed indeterminate by two nuclear medicine physicians not involved in subsequent reading. A targeted SPECT/CT and MR-DWI were read independently by two nuclear medicine physicians and two radiologists, respectively, on a 5-point probability score. The final diagnosis of disease status was formulated from subsequent clinical/imaging follow-up within six months. Results: Agreement between SPECT/CT readers was 0.73 (95% confidence interval [CI]:0.51-0.85) and 0.99 (95%...
Accuracy of plain radiographs in diagnosing biopsy-proven malignant bone lesions
South African Journal of Radiology
Background: The diagnosis of primary bone tumours is a threefold approach based on a combination of clinical, radiological and histopathological findings. Radiographs form an integral part in the initial diagnosis, staging and treatment planning for the management of aggressive/malignant bone lesions. Few studies have been performed where the radiologist's interpretation of radiographs is compared with the histopathological diagnosis. Objectives: The study aimed to determine the frequency of bone tumours at a tertiary hospital in South Africa, and, using a systematic approach, to determine the sensitivity and specificity of radiograph interpretation in the diagnosis of aggressive bone lesions, correlating with histopathology. We also determined the inter-observer agreement in radiograph interpretation, calculated the positive and negative predictive values for aggressive/malignant bone tumours and computed the cumulative effect of multiple radiological signs to determine the yield for malignant bone tumours. Method: A retrospective, descriptive and correlational study was performed, reviewing the histopathological reports of all biopsies performed on suspected aggressive bone lesions during a 3-year period from 2012 to 2014. The radiographs were interpreted by three radiologists using predetermined criteria. The sensitivity and specificity of the readers' interpretation of the radiograph as 'benign/non-aggressive' or 'aggressive/malignant' were calculated against the histology, and the inter-rater agreement of the readers was computed using the Fleiss kappa values. Results: Of the 88 suspected 'aggressive or malignant' bone tumours that fulfilled the inclusion criteria, 43 were infective or malignant and 45 were benign lesions at histology. Reader sensitivity in the diagnosis of malignancy/infective bone lesions ranged from 93% to 98% with a specificity of 53%-73%. The average kappa value of 0.43 showed moderate agreement between radiological interpretation and final histology results. The four radiological signs with the highest positive predictive values were an ill-defined border, wide zone of transition, cortical destruction and malignant periosteal reaction. The presence of all four signs on radiography had a 100% yield for a malignant bone tumour or infective lesion. Conclusion: The use of a systemic approach in the interpretation of bone lesions on radiographs yields high sensitivity but low specificity for malignancy and infection. The presence of benign bone lesions with an aggressive radiographic appearance necessitates continuation of the triple approach for the diagnosis of primary bone tumours.
Differential diagnosis of atypically located single or double hot spots in whole bone scanning
Journal of nuclear medicine : official publication, Society of Nuclear Medicine, 1998
Our study assessed the predictive value of atypically located hot spots in routine 99mTc-DPD (3,3 diphosphono-1, 2-propane dicarboxylic acid tetrasodium salt) bone scanning for osseous tumor spread in patients with a history of malignant tumor. Of 1286 scans in consecutive patients with a history of malignant tumor, but with no current evidence of osseous tumor spread, 172 displayed one or two hot spots in the following locations: transverse process of a single vertebra, manubriosternal junction, unilateral process of L5/S1, unilateral shoulder, costal cartilage, single rib, and unilateral sternoclavicular joint. The final diagnosis could be established by a control bone scan after at least 6 mo, biopsy and/or postmortem, respectively, in 135 patients. Of the atypical hot spots, 11.1% were the first indication for osseous tumor spread. This diagnosis was most probable for single hot spots in the rib (25%) and shoulder (21%). Conversely, hot spots in the sternoclavicular joint never ...
Clinical uses of bone scanning
Skeletal Radiology, 1977
The skeleton is a frequent site of metastatic disease, Radiographic examination is not sufficiently reliable in early detection since an abnormality is unlikely to be observed until more than 50% of the bone material has been lost. Therefore, skeletal scanning represents a viable technique for demonstration of dynamic response of bone to tumor invasion. This technique provides a more sensitive method for detection of early skeletal metastatic disease. Technetium 99m labeled methylenediphosphonate seems to be the best technetium 99m labeled agent for skeletal images, although ethyline hydroxydiphosphonate may be equally good. The toxicity of the compounds is low and repetitive studies can be done for continued clinical evaluation of the patient without significant risk.