Multi-modality imaging approach to bone tumors - State-of-the art

The approach to the radiographic diagnosis of bone tumors is much beyond the conventional radiographs in present era of multiplanar and functional imaging. Radiographs is still the most pertinent part of initial diagnosis of bone tumors, however, there are few limitations, like lesions in complex anatomy, marrow assessment, soft tissue resolution, which are important for staging. Diagnosis is just one aspect of the tumor evaluation, extent of marrow involvement by the tumor growth, involvement of overlying soft tissue, involvement of adjacent joint, and knowledge about skip lesions and metastasis are equally important for staging and treatment of the disease. Multimodality imaging like CT, MRI helps cover all these aspects. Emerging role of PETCT/PET MRI has further revolutionized the imaging of bone tumors by providing anatomical and morphological characteristics simultaneously and combining the whole body scan in same sitting. This article will discuss the role of various imaging modalities along with illustrative examples of few cases. Team work between radiologist with orthopedic oncologist and pathologist will help in deciding a road map for diagnosing and treatment of bone tumors. Follow up scanning with MRI and PET FDG scan has also been well established in assessing therapeutic response.