Artificial Intelligence in Primary Malignant Bone Tumor Imaging: A Narrative Review

Abstract

Artificial Intelligence (AI) has emerged as a transformative force in orthopedic oncology, offering significant advances in the diagnosis, classification, and prediction of treatment response for primary malignant bone tumors (PBT). Through machine learning and deep learning techniques, AI leverages computational algorithms and large datasets to enhance medical imaging interpretation and support clinical decision-making. The integration of radiomics with AI enables the extraction of quantitative features from medical images, allowing for precise tumor characterization and the development of personalized therapeutic strategies. Notably, convolutional neural networks have demonstrated exceptional capabilities in pattern recognition, significantly improving tumor detection, segmentation, and differentiation. This narrative review synthesizes the evolving applications of AI in PBTs, focusing on early tumor detection, imaging analysis, therapy response prediction, and histological classification. AI-driven radiomics and predictive models have yielded promising results in assessing chemotherapy efficacy, optimizing preoperative imaging, and predicting treatment outcomes, thereby advancing the field of precision medicine. Innovative segmentation techniques and multimodal imaging models have further enhanced healthcare efficiency by reducing physician workload and improving diagnostic accuracy. Despite these advancements, challenges remain. The rarity of PBTs limits the availability of robust, high-quality datasets for model development and validation, while the lack of standardized imaging protocols complicates reproducibility. Ethical considerations, including data privacy and the interpretability of complex AI algorithms, also warrant careful attention. Future research should prioritize multicenter collaborations, external validation of AI models, and the integration of explainable AI systems into clinical practice. Addressing these challenges will unlock AI's full potential to revolutionize PBT management, ultimately improving patient outcomes and advancing personalized care.

Keywords: imaging; machine learning; orthopedic oncology; primary bone tumors; radiomics.

Figure 1

The correlations among artificial intelligence, machine learning, and deep learning.

Figure 2

The workflow of search and selection. The search was conducted in December of 2024.

Figure 3

Clustering the studies according to the main area of focus.