Real bone tumors are rarely encountered in the daily routine of radiol
ogical practice. Therefore, for a general radiologist there is no need
for a specialist knowledge on this field. However, he should be able
to distinguish benign from malignant lesions in order to avoid unneces
sary biopsies. A systematic approach towards osteolytic lesions, e. g.
according to the classification of Lodwick, is mandatory. CT and MRI
are indicated to clear up the anatomy in areas of superposition artefa
cts in conventional radiology and to determine the inner structure of
a lesion, e. g. fatty tissue, liquid/solid. This paper highlights the
advantages and disadvantages and the cost-effective use of the imaging
modalities including scintigraphy in the diagnosis of bone tumors and
tumor-like lesions. Guidelines for the management of bony lesions wil
l be given in detail. The option and necessity for a specialist second
opinion is emphasized.