Pediatric vertebral tumors: radiologic features and differential diagnoses

Primary vertebral tumors in children are rare but clinically significant due to their potential for neurological compromise, spinal instability, and growth-related deformities. These lesions encompass a wide histologic spectrum, ranging from benign entities, such as osteoid osteoma and osteoblastoma, to aggressive malignancies like Ewing sarcoma and osteosarcoma. Despite their rarity, timely and accurate diagnosis is essential, as delays can result in irreversible neurological deficits. Imaging is fundamental across the clinical continuum, from detection and characterization to treatment planning and post-therapeutic monitoring. Conventional radiography remains a common first-line tool, although limited in sensitivity for early or subtle findings. Computed tomography (CT) is particularly useful for evaluating cortical integrity and detecting tumor mineralization, findings that are especially relevant in lesions such as osteoid osteoma, where CT also plays a key role in planning and guiding percutaneous treatment. Magnetic resonance imaging (MRI), the modality of choice, offers superior soft tissue contrast and is essential for assessing bone marrow involvement and adjacent neural structures. Advanced MRI techniques, such as diffusion-weighted imaging (DWI) and dynamic contrast-enhanced studies, further enhance lesion characterization and may help predict response to treatment. Minimally invasive techniques, including image-guided biopsy, radiofrequency ablation, and cryoablation, have expanded the therapeutic techniques, particularly for benign lesions. This review provides a comprehensive overview of the classification and imaging features of pediatric spinal bone tumors, with emphasis on the strengths and limitations of each modality and the evolving role of interventional radiology in diagnosis and treatment.