An Approach to Undiagnosed Bone Tumors.

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Abstract

[Indexed for MEDLINE] 4. Semin Musculoskelet Radiol. 2022 Aug;26(4):453-468. doi: 10.1055/s-0042-1753506. Epub 2022 Sep 14. Tumors of the Spine: When Can Biopsy Be Avoided? Weber MA(1), Bazzocchi A(2), Nöbauer-Huhmann IM(3). Author information: (1)Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany. (2)Diagnostic and Interventional Radiology, The Rizzoli Orthopedic Institute, Bologna, Italy. (3)Department of Biomedical Imaging and Image Guided Therapy, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Vienna, Austria. Regarding osseous tumors of the spine, characteristic morphology is encountered in hemangioma of the vertebral body, osteoid osteoma (OO), osteochondroma, Paget's disease, and bone islands. In these cases, radiologic imaging can make a specific diagnosis and thereby avoid biopsy, especially when the radiologist has chosen the correct imaging modality to establish the diagnosis, such as thin-slice computed tomography in suspected OO. A benign lesion is suggested by a high amount of fat within the lesion, the lack of uptake of the contrast agent, and a homogeneous aspect without solid parts in a cystic tumor. Suspicion of malignancy should be raised in spinal lesions with a heterogeneous disordered matrix, distinct signal decrease in T1-weighted magnetic resonance imaging, blurred border, perilesional edema, cortex erosion, and a large soft tissue component. Biopsy is mandatory in presumed malignancy, such as any Lodwick grade II or III osteolytic lesion in the vertebral column. The radiologist plays a crucial role in determining the clinical pathway by choosing the imaging approach wisely, by narrowing the differential diagnosis list, and, when characteristic morphology is encountered, by avoiding unnecessary biopsies. Thieme. All rights reserved. DOI: 10.1055/s-0042-1753506