(iv) The radiological investigation of musculoskeletal malignancy

Bone and soft-tissue tumours are rare; primary bone and soft-tissue sarcomas should be referred to specialist centres. Accurate diagnosis is usually achieved with history, clinical examination and plain radiographs. For bone tumours the patient's age, the site, size and location within the bone, margins, matrix and presence of periosteal reaction or soft-tissue extension all determine biological activity and the diagnosis. Other imaging modalities may supplement the radiological diagnosis but are of greater use in local and distal staging of the disease, surgical planning and surveillance. Soft-tissue tumours are much less easily characterised using radiographs, MRI is the most useful modality. Biopsies are frequently guided by radiological imaging but should be carefully planned in conjunction with the surgeon providing the definitive procedure. New radiological modalities are increasingly being used to support and supplement the management of musculoskeletal oncology patients.