Computed Tomography and Magnetic Resonance Imaging of Bone Tumors.
Semin Roentgenol. 2017 Oct;52(4):209-226. doi: 10.1053/j.ro.2017.04.006. Epub 2017 Apr 12. Ladd LM1, Roth TD2.
Malignant primary bone tumors make up only 0.2% of all malignancies in adults1, 2 and 5% in children from ages 5-15 years.1, 3 Benign bone tumors are more common, but the true prevalence is unknown because they are often asymptomatic and go undiscovered. The clinical presentation of bone tumors can be challenging. The nonspecific gradual onset of pain and swelling in most malignant tumors and asymptomatic nature of many benign tumors1, 4 reinforce the importance of the radiologist׳s role in detecting, working up, and staging bone lesions. It is important for radiologists to recognize imaging features that can distinguish nonaggressive incidental tumors from those that are aggressive or potentially malignant. In some cases, a specific diagnosis may be rendered based on patient age, lesion location, and recognition of characteristic imaging features. In other cases, a short list of the most likely differential diagnoses can be provided to help guide further workup and management.
Furthermore, imaging plays a central role in the staging of malignant bone tumors. For over 30 years, a bone tumor-specific system by Enneking5 has been used. Although this is still used by some orthopedists and extensively used in the radiology literature, the recent focus on multidisciplinary team-based care has resulted in a shift to use the American Joint Commission on Cancer (AJCC) system. Both classifications are discussed in a review by Balach and colleagues.4