Radiologic staging of musculoskeletal tumors

The staging of primary malignant bone and soft tissue tumors requires adher ence to a unified staging system. The staging system of the American Joint Commission for Cancer, the Enneking system, and the Hajdu system are descri bed in respect of the radiologic staging criteria. Plain film radiography c an estimate the biological aggressiveness of a bone tumor and in many cases narrow the differential diagnosis. Computed tomography is most sensitive i n depicting cortical erosions and calcified periosteal reactions as well as in screening for distant metastasis. Angiography is mainly employed for va scular tumors and for the monitoring of interventional procedures such as t umor embolization. For both bone and soft tissue tumors, magnetic resonance tomography is the method of choice for the staging of intra- and extramedu llary tumor extension,for the differentiation of neighboring compartments, and in the detection of invasion of the regional neurovascular bundle. Afte r administration of contrast agents, the mode of enhancement gives further information on the nature of the tumor. With consistent application of the staging criteria in preoperative imaging, limb-saving therapy can be employ ed more often and the prognosis of the disease can be improved.