In contrast, results of a multi-institutional collaborative study assessing the relative accuracy of CT and MRI in the local staging of primary malignant musculoskeletal neoplasms showed no statistically significant difference between CT and MRI in determining tumor involvement of muscle, bone, joints, or neurovascular structures [23]. Furthermore, the combined interpretation of CT and MRI did not significantly improve accuracy [23]. However, a more recent retrospective study comparing the diagnostic accuracy of radiographs, CT, MRI, bone scintigraphy, and FDG-PET/CT versus pathology reports in 409 biopsy-proven tumors showed that the sensitivity of MRI and FDG-PET/CT was better than that of CT, bone scintigraphy, and radiographs. In spine lesions, MRI was the most sensitive modality for detection of tumors, followed by FDG-PET/CT and CT [38]. Several studies have shown that contrast-enhanced MRI and MR angiography can provide additional information (eg, more accurate characterization, evaluation of viability, and biopsy planning) for the preoperative evaluation of primary bone tumors [39-41]. In a study of 37 patients with cartilaginous tumors, Geirnaerdt et al [42] evaluated the utility of fast contrast-enhanced MRI in differentiating benign from malignant tumors. They found that differentiation of malignancy from benignity was possible with this technique, with a sensitivity of 61% and specificity of 95%. The usefulness of MRI with dynamic contrast enhancement in characterizing lesions as benign or malignant has been evaluated in several additional studies with mixed results [43,44]. Other imaging techniques, such as diffusion-weighted and chemical shift MRI, have been shown to be useful in differentiating benign from malignant bone tumors [45-47]. MRI with dynamic contrast enhancement [43], as well as diffusion and chemical shift MRI [47], can help differentiate benign from malignant spinal compression fractures.
Primary Bone Tumors. In contrast, results of a multi-institutional collaborative study assessing the relative accuracy of CT and MRI in the local staging of primary malignant musculoskeletal neoplasms showed no statistically significant difference between CT and MRI in determining tumor involvement of muscle, bone, joints, or neurovascular structures [23]. Furthermore, the combined interpretation of CT and MRI did not significantly improve accuracy [23]. However, a more recent retrospective study comparing the diagnostic accuracy of radiographs, CT, MRI, bone scintigraphy, and FDG-PET/CT versus pathology reports in 409 biopsy-proven tumors showed that the sensitivity of MRI and FDG-PET/CT was better than that of CT, bone scintigraphy, and radiographs. In spine lesions, MRI was the most sensitive modality for detection of tumors, followed by FDG-PET/CT and CT [38]. Several studies have shown that contrast-enhanced MRI and MR angiography can provide additional information (eg, more accurate characterization, evaluation of viability, and biopsy planning) for the preoperative evaluation of primary bone tumors [39-41]. In a study of 37 patients with cartilaginous tumors, Geirnaerdt et al [42] evaluated the utility of fast contrast-enhanced MRI in differentiating benign from malignant tumors. They found that differentiation of malignancy from benignity was possible with this technique, with a sensitivity of 61% and specificity of 95%. The usefulness of MRI with dynamic contrast enhancement in characterizing lesions as benign or malignant has been evaluated in several additional studies with mixed results [43,44]. Other imaging techniques, such as diffusion-weighted and chemical shift MRI, have been shown to be useful in differentiating benign from malignant bone tumors [45-47]. MRI with dynamic contrast enhancement [43], as well as diffusion and chemical shift MRI [47], can help differentiate benign from malignant spinal compression fractures.