Validation of American College of Radiology Bone Reporting and Data System (ACR Bone-RADS) for risk stratification of...

Neoplastic bone lesions show huge divergence. Accurate diagnosis is mandatory for optimal management. Computed tomography (CT) is of special importance in characterisation of bone tumuors, especially in complex anatomical areas and the axial skeleton. This study aimed to test the validity of applying American College of Radiology (ACR) Bone Reporting and Data System (Bone-RADS) in interpreting bony lesions on CT to gain evidence supporting its implementation as a standard in reporting and communication with orthopaedic surgeons.

This retrospective study involved 336 patients (mean age; 30.3 ± 18.8, 190, 56.5% males) whose CT scans detected neoplastic bony lesions in the period from January 2021 to December 2024. Three radiologists independently reviewed CT exams and set Bone-RADS scores. Inter-reader agreement among the three readers was assessed, and validity of the results was tested.

There were 227 benign, 16 intermediate, and 93 malignant lesions. The overall inter-reader agreement among two musculoskeletal radiologists and one nonmusculoskeletal radiologist was substantial to perfect (k: 0.66 to 1). The diagnostic performance for identifying intermediate or malignant lesions varied among radiologists with sensitivities ranging from 96.8% to 100%, specificities from 62.9% to 92.7%, and accuracies from 74.3% to 94%.

The implementation of ACR Bone-RADS for CT imaging demonstrates robust reproducibility, high sensitivity, and accuracy in characterising bone lesions, thereby enhancing diagnostic confidence and informing clinical decision-making. These findings support the adoption of ACR Bone-RADS as a uniform reporting framework for bone lesions identified on radiographic and CT examinations.