Radiography Area of Interest Although there is no relevant literature specifically regarding recommendations for follow-up of bone lesions incidentally found on MRI, radiographic evaluation of the area of interest is generally considered the initial study of choice in this situation. Initial radiographs not only provide an accurate means by which to evaluate primary Primary Bone Tumors bone tumors but also provide a baseline study for a bone lesion that may be followed radiographically. Radiographs provide information regarding tumor location, size, and shape as well as evidence of tumor biological activity [3]. Tumor margin and periosteal reaction provide a reliable index of biological potential of the tumor, whereas matrix, if identified, is a key to the underlying histology [3-6]. Although the utility of radiographs in stratifying bone lesions into aggressive and nonaggressive categories is well established, there is sparse literature documenting concrete values on accuracy. A prospective study evaluating 200 consecutive bone tumors of the hand showed that subjective grading of tumors based on radiographic features provided a correct categorization of tumor grade (benign versus malignant) in 82.5% of cases [7]. In a retrospective study applying a modified Lodwick-Madewell grading system to categorize 183 bone tumors, Caracciolo et al [8] found that a low radiographic grade assignment correlates with benignity and that increasing grade correlates with an increasing risk of malignancy. In the case of an incidental lesion on CT, radiographic evaluation of the area of interest may be helpful in allowing for assessment of the lesion based on well-established radiographic criteria. However, radiographs are unlikely to add any additional information specifically about matrix mineralization or cortical involvement that is not readily evident on CT. This is especially true if a high-quality CT with multiplanar reformatting in the coronal and sagittal planes was obtained.
Primary Bone Tumors. Radiography Area of Interest Although there is no relevant literature specifically regarding recommendations for follow-up of bone lesions incidentally found on MRI, radiographic evaluation of the area of interest is generally considered the initial study of choice in this situation. Initial radiographs not only provide an accurate means by which to evaluate primary Primary Bone Tumors bone tumors but also provide a baseline study for a bone lesion that may be followed radiographically. Radiographs provide information regarding tumor location, size, and shape as well as evidence of tumor biological activity [3]. Tumor margin and periosteal reaction provide a reliable index of biological potential of the tumor, whereas matrix, if identified, is a key to the underlying histology [3-6]. Although the utility of radiographs in stratifying bone lesions into aggressive and nonaggressive categories is well established, there is sparse literature documenting concrete values on accuracy. A prospective study evaluating 200 consecutive bone tumors of the hand showed that subjective grading of tumors based on radiographic features provided a correct categorization of tumor grade (benign versus malignant) in 82.5% of cases [7]. In a retrospective study applying a modified Lodwick-Madewell grading system to categorize 183 bone tumors, Caracciolo et al [8] found that a low radiographic grade assignment correlates with benignity and that increasing grade correlates with an increasing risk of malignancy. In the case of an incidental lesion on CT, radiographic evaluation of the area of interest may be helpful in allowing for assessment of the lesion based on well-established radiographic criteria. However, radiographs are unlikely to add any additional information specifically about matrix mineralization or cortical involvement that is not readily evident on CT. This is especially true if a high-quality CT with multiplanar reformatting in the coronal and sagittal planes was obtained.