Systematic Imaging Evaluation and Reporting of Primary Bone Tumor using BTI-RADS

• Background: To is to define the main imaging features to differentiate between benign and malignant primary bone tumors and to determine efficacy of the new systemic approach (BTI-RADS) in bone tumor stratification and its role in enabling radiologists to communicate results to the referring physician clearly and consistently. • Methods: A cross-section study From November 2021 to December 2023, it included 36 patients referred from orthopedics department to radio-diagnosis department to assess a preliminary diagnosed primary focal bony lesion, all of them were evaluated with X-ray, CT and MRI. • Results: We applied our study on 36 patients (23 men and 13 women; age range, 10 - 70 years).and we found a good agreement between BTI-RADS and gold standard results (K=0.658). The value was highly significant (P value <0.001).BTI-RADS agreed with gold standard results in (90%) true malignant cases and (75%) of true benign cases, while there were (25%) false negative cases (diagnosed as benign lesions by BTI-RADS but were proven to be malignant by histopathology) and (10%) false positive cases (diagnosed as malignant masses by BTI-RADS but were proven to be benign by histopathology). • Conclusion A systematic, evidence-based classification method is proposed, which reliably stratifies bone lesions into four groups based on their malignancy risk. This approach is reproducible across varying levels of reader expertise and aims to standardize bone tumor evaluations, potentially improving patient management.