Can Bone-RADS and OT-RADS Accurately Guide Pediatric MRI?

Clinicians frequently encounter solitary bone lesions in children and young adolescents. Consequently, standardizing magnetic resonance imaging (MRI) interpretations remains critical to avoid unnecessary biopsies. To address this need, researchers evaluated Bone-RADS and OT-RADS in pediatric patients with solitary bone lesions. Importantly, the investigation verified whether adult-oriented classification criteria perform reliably in pediatric cohorts.

Validating Bone-RADS and OT-RADS in Pediatric Cohorts

The retrospective study reviewed eighty patients younger than eighteen years who underwent MRI for solitary bone tumors. Specifically, five radiologists with varying levels of clinical experience independently scored all imaging examinations. The readers applied both Bone-RADS and OT-RADS algorithms across original categorical scales and binary diagnostic models. Furthermore, the team assessed inter-rater reliability using Cohen's kappa and Fleiss' kappa statistics. In addition, researchers evaluated diagnostic accuracy by separating lesions into benign and malignant categories.

Diagnostic Performance and Inter-Rater Reliability

Overall, both classification systems demonstrated moderate inter-observer agreement among all readers. Specifically, Bone-RADS achieved a Fleiss kappa of 0.470 across the five raters. In comparison, OT-RADS yielded an overall Fleiss kappa of 0.432. However, their diagnostic accuracy differed across individual reader experience levels. Bone-RADS showed moderate to good diagnostic accuracy throughout the cohort. Meanwhile, OT-RADS demonstrated moderate to excellent diagnostic accuracy. Thus, both systems successfully discriminated between benign lesions and malignant neoplasms.

Clinical Takeaways for Indian Radiologists and Surgeons

Bone-RADS provides a structured algorithm that substantially reduces reporting ambiguity for general radiologists. Consequently, this algorithmic design explains why Bone-RADS achieved higher inter-rater agreement. In contrast, OT-RADS lacks a comprehensive standardized lexicon and step-by-step algorithm. Therefore, OT-RADS relies heavily on the reader's baseline disease knowledge. For Indian centers managing pediatric bone lesions, Bone-RADS offers a straightforward triage framework. As a result, practicing clinicians can confidently utilize these MRI systems to guide management, further enhanced by pursuing specialized training through a Certification Course In Paediatrics Radiology.

Frequently Asked Questions

Q1: Can radiologists use Bone-RADS and OT-RADS safely in pediatric patients?

Yes, both systems demonstrated dependable accuracy and moderate inter-rater reliability in evaluating solitary pediatric bone lesions on MRI.

Q2: Why did Bone-RADS achieve higher inter-rater agreement than OT-RADS?

Bone-RADS utilizes an explicit step-by-step algorithm, whereas OT-RADS depends more heavily on specific pathological disease familiarity.

Q3: How do these scoring systems assist pediatric orthopedic referrals?

Furthermore, standardized scoring clarifies lesion risk, preventing unnecessary invasive biopsies while ensuring timely oncologic referrals.

References

1. Sağlam D et al. 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. Eur Radiol. 2026 Sep 17. doi: 10.1007/s00330-026-12899-5. PMID: 42752923.
2. Ghasemi A, Ahlawat S. Bone Reporting and Data System (Bone-RADS) and Other Proposed Practice Guidelines for Reporting Bone Tumors. Rofo. 2024 Nov;196(11):1134-1142. doi: 10.1055/a-2262-8411. PMID: 38490222.
3. American College of Radiology. Bone Tumor Risk Stratification and Management System: A Consensus Guideline from the ACR Bone Reporting and Data System Committee. JACR. 2023.