Evaluation of the Bone Reporting and Data System (Bone-RADS) on computed tomography in children with solitary bone...

The Bone Reporting and Data System (Bone-RADS) has been developed to facilitate and provide a common language for the management of bone tumors in adults. No bone reporting system has been developed to evaluate solitary bone lesions in children.

This study aims to evaluate the interrater agreement and diagnostic performance of Bone-RADS in children with solitary bone lesions on computed tomography (CT).

From January 2014 to January 2026, patients <18 years old with bone lesions and a CT available in our picture archiving and communication system (PACS) were identified for eligibility. Five raters evaluated the CT images after a senior radiologist's informative lecture on Bone-RADS. The final diagnosis, accepted as the reference standard, was determined by a multidisciplinary team based on biopsy or at least 2 years of follow-up. Interrater agreement was assessed. A binary Bone-RADS categorization was also used for diagnostic performance evaluation.

Seventy-four patients (22 females) with a mean age of 12.5±3.4 (range, 3-17) years old were enrolled in the study. The interrater agreement among all raters was almost perfect for both Bone-RADS and the binary Bone-RADS classification (P<0.001). Except for one non-advanced rater, all individual agreements with the reference standard were substantial in Bone-RADS (P<0.001). Binary Bone-RADS classification showed high accuracy, ranging from 81.1% to 90.5% across all raters.

Bone-RADS on CT showed high interrater agreement and diagnostic performance in children with solitary bone lesions. Bone-RADS on CT may be used in children to manage solitary bone lesions.