Predictors of lesion detection sensitivity in oncology imaging patients with musculoskeletal trauma

Chiara Ricci; L. Greco; M. Conti

doi:10.5281/zenodo.22814149

Authors

Chiara Ricci Department of Clinical Medical Imaging, Kama Institute of Clinical Radiology Author https://orcid.org/7152-5552-1480-159X
L. Greco Department of Clinical Radiology, Mekong Research Center for Medical Imaging Author https://orcid.org/7125-9032-0263-2169
M. Conti Department of Clinical Radiology, Godavari Institute for Advanced Clinical Radiology Author https://orcid.org/8138-0942-4400-2873

DOI:

https://doi.org/10.5281/zenodo.22814149

Keywords:

lesion detection sensitivity, musculoskeletal trauma, oncology imaging, whole-body MRI, PET-CT

Abstract

Graphical abstract

Background: Detecting oncologic bone lesions in patients with concurrent musculoskeletal trauma is a recurring diagnostic problem, because fracture-related marrow edema, periosteal reaction, and hematoma can mask or mimic the imaging features that ordinarily flag malignancy.

Objective: This review synthesizes published evidence on predictors of lesion detection sensitivity across radiography, MRI, bone scintigraphy, and PET-CT in oncology patients whose skeletal imaging is complicated by trauma, and identifies the factors that most strongly modify sensitivity.

Methods: We synthesized diagnostic-accuracy studies, multireader trials, and technical-optimization reports addressing lesion conspicuity, reader experience, modality, lesion size and location, and trauma-related confounding in skeletal oncologic imaging.

Findings: Whole-body MRI and PET-CT outperform radiography and bone scintigraphy for small, marrow-based lesions, while superimposed trauma lowers sensitivity by obscuring lesion margins and generating false-positive marrow signal; reader experience, lesion size, and structured double-reading protocols each independently modify observed sensitivity.

Conclusions: Lesion detection sensitivity with concurrent trauma is multifactorial, shaped by modality, lesion size and location, trauma-related confounding, and reader factors, and can be improved through diffusion-weighted whole-body MRI, dual reading, and structured reporting.

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