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. 2025 Jul 17;16(1):155.
doi: 10.1186/s13244-025-02040-3.

Bone Reporting and Data System on MRI (Bone-RADS-MRI): a validation study by four readers on 275 cases from three local and two public databases

Yue Xing #  1   2 , Yangfan Hu #  1   2 , Xianwei Liu #  1   2 , Defang Ding  1   2 , Shun Dai  1   2 , Liangjing Lyu  1   2 , Guangcheng Zhang  3 , Shiqi Mao  4 , Qian Yin  5 , Junjie Lu  6 , Jiarui Yang  7 , Yang Song  8 , Huan Zhang  9 , Chengzhou Li  10 , Weiwu Yao  11   12 , Jingyu Zhong  13   14
Affiliations

Bone Reporting and Data System on MRI (Bone-RADS-MRI): a validation study by four readers on 275 cases from three local and two public databases

Yue Xing et al. Insights Imaging. .

Abstract

Objective: To evaluate the reproducibility and effectiveness of the Bone Reporting and Data System on MRI (Bone-RADS-MRI) for incidental solitary bone lesions in adults.

Materials and methods: We retrospectively included 275 MRI cases from three local and two public databases, respectively. All the cases were histopathologically or clinically confirmed bone lesions, or "do not touch" lesions with typical appearance and remained stable for at least two years. Each lesion with gender, age, and clinical history was categorized according to the Bone-RADS algorithm by two musculoskeletal radiologists and two non-musculoskeletal radiologists. The Bone-RADS categories were as follows: Bone-RADS-1, likely benign, leave alone; Bone-RADS-2, incompletely assessed on imaging, perform different imaging modality; Bone-RADS-3, intermediate, perform follow-up imaging; Bone-RADS-4, suspicious for malignancy or need for treatment, biopsy and/or oncologic referral. Inter-reader agreement was evaluated. The diagnostic performance of the Bone-RADS-MRI was measured for distinguishing intermediate or malignant lesions or osteomyelitis from benign lesions. The histopathology results, clinical diagnosis, or follow-up were used as a standard reference.

Results: There were 165 intermediate or malignant lesions or osteomyelitis, and 110 benign lesions, respectively. The inter-reader agreements between two musculoskeletal and between two non-musculoskeletal radiologists were both moderate (weighted kappa 0.572 and 0.520). The diagnostic performance for identifying intermediate or malignant lesions or osteomyelitis ranged according to radiologists with sensitivities of 88.5% to 94.5%, specificities of 55.5% to 74.5%, and accuracies of 76.4% to 82.9%.

Conclusion: Bone-RADS-MRI is effective for identifying bone lesions that need further treatment, but it has only moderate reliability for readers with different specialties and experience.

Critical relevance statement: With local and public databases, Bone-RADS-MRI has been demonstrated to be a reliable algorithm for musculoskeletal and non-musculoskeletal radiologists with varying experience and an effective tool for identifying incidental solitary bone lesions that "need treatment" in adults.

Key points: Bone-RADS-MRI needs clinical validation for inter-reader agreement and diagnostic performance. Bone-RADS-MRI achieved moderate agreements between musculoskeletal and non-musculoskeletal radiologists, respectively. Bone-RADS-MRI presented high sensitivities but low specificities for identifying "need-for-treatment" bone lesions.

Keywords: Bone neoplasms; Clinical decision-making; Magnetic resonance imaging; Reproducibility of results.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Institutional Review Board approval was obtained from Tongren Hospital, Shanghai Jiao Tong University School of Medicine (2024-084-01). Consent for publication: Written informed consent was waived by the Institutional Review Board. Competing interests: Dr. Jingyu Zhong acknowledges his position as a member of the Scientific Editorial Board of European Radiology, Insights into Imaging, American Journal of Roentgenology, and BMC Medical Imaging. He has therefore not taken part in the review or selection processes of this paper. Dr. Yang Song is an employee of Siemens Healthineers Ltd. However, he is a collaborative scientist doing technical support under Siemens' collaboration regulation without any payment and personal concern regarding this study. He neither had access nor control over the data acquisition and analysis. All other authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Figures

Fig. 1
Fig. 1
Bone-RADS-MRI and workflow of the study. Bone-RADS, Bone Reporting and Data System; MSKCC, musculoskeletal cancer center; PACS, picture archiving and communication system
Fig. 2
Fig. 2
Bar plot of Bone-RADS rating according to readers
Fig. 3
Fig. 3
Histogram of diagnostic performance of Bone-RADS according to readers
See this image and copyright information in PMC

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