The purpose of this study was to assess the diagnostic performance of compu
ted direct magnification radiography in diagnosing bone tumors as compared
with conventional radiography. Ninety-one patients with primary bone tumors
and tumor-like lesions were radiographed with conventional and magnificati
on techniques. All radiographs were analyzed by one orthopedic surgeon and
two radiologists and the findings were correlated with histopathology. Two
microfocal X-ray units were used for computed direct magnification radiogra
phy with a focal spot size of 20-130 mum. Using magnification versus conven
tional radiography, the diagnosis of benign and malignant lesions as well a
s the individual tumor diagnosis was obtained with higher accuracy (85% ver
sus 71% and 69% versus 51%, respectively, P < 0.01). Margins of destruction
, periosteal reactions, and matrix patterns were evaluated with higher accu
racy by all observers (P < 0.01). We conclude that computed direct magnific
ation radiography may improve evaluation and diagnosis of bone tumors.