Evaluation of focal bone lesions: basic principles and clinical scenarios

The plain film is essential to reveal biological behaviour of the entire lesion. The plain film often suggests the tissue of origin. Lesion location (in both the longitudinal and transverse planes of the bone) and patient age narrow the differential diagnosis. Certain tumours and tumour-like conditions occur in characteristic locations, for example simple bone cysts and chordomas. If a diagnosis cannot be made from radiographs, CT may yield further diagnostic information. Staging MRI should be performed before any biopsy. Referral to a bone tumour unit may be required for diagnostic assistance from imaging, or for biopsy. The latter is more appropriately performed in a specialist centre.