Classifications for radiographic evaluation of radiolucent bone lesions have poor inter- and intra-observer agreement.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: Declarations. Ethics approval and consent to participate: This study was subject to ethics board approval and deemed IRB exempt (SUNY Upstate IRB, Syracuse, NY #2191652-1). Participants were limited to voluntary and informed orthopedic trainees and faculty. All included images were deidentified. Consent for publication: Not applicable. Competing interests: One author (TAD) has received funding from: BMC Musculoskeletal Disorders: Editorial or governing board. Bone Support (Cerament): Paid consultant. BoneSupport (Cerament): Research support. Clinical Orthopaedics and Related Research: Editorial or governing board. eMedicine: Editorial or governing board; Publishing royalties, financial or material support. Journal of Orthopaedic Research: Editorial or governing boardJournal of Surgical Oncology: Editorial or governing board. Journal of the American Academy of Orthopaedic Surgeons: Publishing royalties, financial or material support. Medicina: Editorial or governing board. Open Journal of Orthopedics: Editorial or governing board. OREF: Research support. PLOS One: Editorial or governing board. Stryker: Research support. Up To Date: Publishing royalties, financial or material support. Wolters Kluwer Health - Lippincott Williams & Wilkins: Publishing royalties, financial or material support. Wright Medical Technology, Inc.: Research support. The remaining authors (TJW, SMP, KAM, SC) do not have any disclosures. 11. Orthopade. 2019 Sep;48(9):727-734. doi: 10.1007/s00132-019-03786-7. [The importance of radiology in bone sarcoma diagnostics : Initial and advanced diagnostics]. [Article in German] Vieth V(1). Author information: (1)Klinik für Radiologie, Klinikum Ibbenbüren, Große Straße 41, 49477, Ibbenbüren, Deutschland. v.vieth@klinikum-ibbenbueren.de. BACKGROUND: Reliable diagnostic assessment of malignant bone lesions remains a challenge in all the medical disciplines involved. The high incidence of benign (mainly pediatric) bone lesions needs to be distinguished from the rare malignant counterparts. If clinical presentation and patient history are unable to exclude a malignant tumour, adequate imaging of the affected region is necessary. OBJECTIVES: This article focuses on giving implementable advice in dealing with problems and questions arising in the diagnostic process of treating patients with suspected or confirmed bone sarcoma. Also, follow-up recommendations from a radiological point of view are presented. METHODS: Review and discussion of relevant literature against personal experiences in the medical imaging of patients with bone sarcomas. RESULTS: Interpretation of projection radiographic images usually succeeds in assessing a bone tumour's dignity by evaluating periosteal reaction, the formation of a tumour matrix and consideration of the Lodwick classification. A current adaptation of the classic Lodwick classification incorporates diagnostic possibilities of more recent imaging techniques (magnetic resonance imaging (MRI), positron emission tomography (PET)) and is presented in this article. Plain radiographs are superseded by MRI as the primary imaging performed when depicting bone lesions with increasing frequency. The role of MRI in terms of primary diagnostics, staging, planning of biopsy tracts and tumour resections, evaluation of treatment response and follow-up are discussed. All diagnostic imaging techniques, including whole-body imaging methods, relevant in the diagnosis and therapy of bone sarcomas are presented in the sequence in which they appear during treatment. CONCLUSIONS: Radiological imaging and expertise are important pillars in diagnosis and treatment of bone sarcomas. A variety of complementing imaging techniques provide a treatment-relevant basis significant for all medical disciplines involved. DOI: 10.1007/s00132-019-03786-7