European radiology · 2026
Can bone tumor radiology reporting systems be used in children?: a validation study for Bone-RADS and OT-RADS in MRI in the evaluation of solitary bone tumors.
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Sağlam Dilek, Kaya Hasan Emin, Erdemli Gürsel Başak, Özdemir Ülkünur, Gökalp Gökhan, Sarısözen Bartu, Yalçınkaya Ulviye, Yazıcı Zeynep
Аннотация
OBJECTIVES: Bone tumor radiology reporting systems have been developed, including Bone-RADS and OT-RADS, aimed at standardizing imaging studies' reports and guiding the management of bone lesions. This study aims to evaluate and compare the use of Bone Tumor Radiology Reporting Systems, Bone-RADS and OT-RADS, in MRI of children with solitary bone lesions.
MATERIALS AND METHODS: Patients younger than 18 years old who had an MRI for the evaluation of a solitary bone lesion between January 2015 and October 2025 were included in the study. Five radiologists with different expertise levels evaluated the MRI examinations. Bone-RADS and OT-RADS were assessed using both their original categorical systems and binary classification models. We assessed inter-rater reliability using Cohen's kappa and Fleiss' kappa. For both scoring systems, a binary classification was used to assess diagnostic performance.
RESULTS: Eighty patients (mean age - standard deviation/minimum-maximum: 11.95 - 3.65/4-17 years old; 66 male) were included in the study. For both Bone-RADS and OT-RADS, the overall agreement between all raters, as assessed using Fleiss Kappa, showed moderate agreement (k = 0.470, 95% CI: 0.410-0.530) and (k = 0.432, 95% CI: 0.389-0.475), respectively. The accuracy of Bone-RADS ranged from moderate to good, and OT-RADS from moderate to excellent.
CONCLUSION: Both Bone-RADS and OT-RADS were reliable, and demonstrated high accuracy in evaluating solitary bone tumors in children. Bone-RADS has a higher level of interrater agreement, which we attributed to the guidance provided by its algorithm. OT-RADS requires knowledge of each disease due to the lack of a comprehensive lexicon and an algorithm.
KEY POINTS: Question Can bone tumor radiology reporting systems, Bone-RADS and OT-RADS in MRI, be used in the evaluation of solitary bone tumors? Findings Both Bone-RADS and OT-RADS demonstrated moderate interrater agreement in the evaluation of solitary bone tumors in children. Bone-RADS revealed moderate to good accuracy, while OT-RADS revealed moderate to excellent accuracy. Clinical relevance Bone-RADS and OT-RADS were reliable and demonstrated high accuracy in evaluating solitary bone tumors in children. These bone reporting systems can be used for solitary bone tumors in children on MRI.
MATERIALS AND METHODS: Patients younger than 18 years old who had an MRI for the evaluation of a solitary bone lesion between January 2015 and October 2025 were included in the study. Five radiologists with different expertise levels evaluated the MRI examinations. Bone-RADS and OT-RADS were assessed using both their original categorical systems and binary classification models. We assessed inter-rater reliability using Cohen's kappa and Fleiss' kappa. For both scoring systems, a binary classification was used to assess diagnostic performance.
RESULTS: Eighty patients (mean age - standard deviation/minimum-maximum: 11.95 - 3.65/4-17 years old; 66 male) were included in the study. For both Bone-RADS and OT-RADS, the overall agreement between all raters, as assessed using Fleiss Kappa, showed moderate agreement (k = 0.470, 95% CI: 0.410-0.530) and (k = 0.432, 95% CI: 0.389-0.475), respectively. The accuracy of Bone-RADS ranged from moderate to good, and OT-RADS from moderate to excellent.
CONCLUSION: Both Bone-RADS and OT-RADS were reliable, and demonstrated high accuracy in evaluating solitary bone tumors in children. Bone-RADS has a higher level of interrater agreement, which we attributed to the guidance provided by its algorithm. OT-RADS requires knowledge of each disease due to the lack of a comprehensive lexicon and an algorithm.
KEY POINTS: Question Can bone tumor radiology reporting systems, Bone-RADS and OT-RADS in MRI, be used in the evaluation of solitary bone tumors? Findings Both Bone-RADS and OT-RADS demonstrated moderate interrater agreement in the evaluation of solitary bone tumors in children. Bone-RADS revealed moderate to good accuracy, while OT-RADS revealed moderate to excellent accuracy. Clinical relevance Bone-RADS and OT-RADS were reliable and demonstrated high accuracy in evaluating solitary bone tumors in children. These bone reporting systems can be used for solitary bone tumors in children on MRI.