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Diagnostic performance and inter-reader reliability of bone reporting and data system (Bone-RADS) on computed tomography

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Abstract

Objective

To evaluate the diagnostic performance and inter-reader reliability of the Bone Reporting and Data System (Bone-RADS) for solitary bone lesions on CT.

Materials and methods

This retrospective analysis included 179 patients (mean age, 56 ± 18 years; 94 men) who underwent bone biopsies between March 2005 and September 2021. Patients with solitary bone lesions on CT and sufficient histopathology results were included. Two radiologists categorized the bone lesions using the Bone-RADS (1, benign; 4, malignant). The diagnostic performance of the Bone-RADS was calculated using histopathology results as a standard reference. Inter-reader reliability was calculated.

Results

Bone lesions were categorized into two groups: 103 lucent (pathology: 34 benign, 12 intermediate, 54 malignant, and 3 osteomyelitis) and 76 sclerotic/mixed (pathology: 46 benign, 2 intermediate, 26 malignant, and 2 osteomyelitis) lesions. The Bone-RADS for lucent lesions had sensitivities of 95% and 82%, specificities of 11% and 11%, and accuracies of 57% and 50% for readers 1 and 2, respectively. The Bone-RADS for sclerotic/mixed lesions had sensitivities of 75% and 68%, specificities of 27% and 27%, and accuracies of 45% and 42% for readers 1 and 2, respectively. Inter-reader reliability was moderate to very good (κ = 0.744, overall; 0.565, lucent lesions; and 0.851, sclerotic/mixed lesions).

Conclusion

Bone-RADS has a high sensitivity for evaluating malignancy in lucent bone lesions and good inter-reader reliability. However, it has poor specificity and accuracy for both lucent and sclerotic/mixed lesions. A possible explanation is that proposed algorithms heavily depend on clinical features such as pain and history of malignancy.

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Data availability

The datasets generated and analyzed during the current study are available from the corresponding author on resonable request.

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Funding

This research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HI19C1085) and by a 2024 research grant from Pusan National University Yangsan Hospital.

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Authors and Affiliations

  1. Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea

    Chankue Park

  2. Division of Musculoskeletal Imaging and Intervention, Department of Radiology, University of Washington, Seattle, WA, USA

    Chankue Park, Arash Azhideh, Atefe Pooyan, Ehsan Alipour, Sara Haseli & Majid Chalian

  3. OncoRad Research Core, Department of Radiology, University of Washington/Fred Hutchinson Cancer Center, Seattle, WA, USA

    Chankue Park, Arash Azhideh, Atefe Pooyan, Ehsan Alipour, Sara Haseli & Majid Chalian

  4. Department of Radiology, University of Wisconsin, Madison, WI, USA

    Ishan Satwah

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  1. Chankue Park
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  2. Arash Azhideh
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  3. Atefe Pooyan
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Correspondence to Majid Chalian.

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Park, C., Azhideh, A., Pooyan, A. et al. Diagnostic performance and inter-reader reliability of bone reporting and data system (Bone-RADS) on computed tomography. Skeletal Radiol 54, 209–217 (2025). https://doi.org/10.1007/s00256-024-04721-4

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  • DOI: https://doi.org/10.1007/s00256-024-04721-4

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