Conventional Radiography and Computed Tomography

Conventional radiography is the basic imaging modality for the diagnosis of primary bone tumors of the spine, readily available, often the first examination performed in patients presenting with spinal symptoms such as back pain, mass, or scoliosis. The major limitation is lesion identification in complex anatomy and superimposition. Weight-bearing radiographs are key to assessing the alignment of the spine as this information is not provided by other imaging modalities. It may help the surgeon in making a decision regarding overall spinal balance and need for stabilization. Multidetector CT allows precise anatomical delineation and evaluation of the lesions in complex anatomical locations, where radiographs are not sufficient. Visualization of minor bony changes, tumor mineralization, small calcifications, cortical changes, and periosteal reactions is best possible on CT scan. The lack of characterization of soft tissue along with the lack of precise extent of medullary involvement, which is important for staging, is a major limitation of CT for precise delineation of the lesion extent. MRI can overcome this problem. CT plays an important role in performing imaging-guided biopsy. All three imaging modalities have complementary value with specific advantages for each modality and are often performed together in each individual patient with spinal tumor.