Challenging bone biopsies: what radiologists needs to know

Bone biopsies play a pivotal role in the diagnostic workup of a wide range of bone pathologies. In many cases, image-guided percutaneous biopsy is favored over surgical approaches because it is minimally invasive, highly accurate, cost-efficient, and associated with lower morbidity. Among the available imaging modalities, CT guidance offers superior spatial resolution and enables precise needle placement, but certain skeletal locations remain technically demanding even under CT guidance. This review focuses on challenging CT-guided bone biopsy scenarios, including lesions adjacent to critical neurovascular or spinal structures, densely sclerotic lesions, and lesions occult on CT, and illustrates practical decision-making through representative clinical cases.