Bone-RADS MRI for Vertebral Lesions: 100% NPV for Category 1 but Low Malignancy Rate for Indeterminate Lesions

Bone-RADS 1 on MRI had 100% NPV for vertebral lesions (95% CI 94.7-100%, n=46). Bone-RADS 2/3 lesions had 3.4% malignancy rate, falling to 0% with clinical criteria. Inter-reader agreement was moderate (κ=0.60).

• Bone-RADS 1 showed 100% negative predictive value (95% CI 94.7–100%) in 46 lesions, meaning no false negatives for malignancy.
• The positive predictive value for indeterminate lesions (Bone-RADS 2/3) was 3.4% (95% CI 1.2–8.0%), which decreased to 0% when exclusionary clinical criteria were incorporated.
• Inter-reader reliability was moderate (Cohen's kappa 0.60), and 80% of original reports advised follow-up for lesions later scored as Bone-RADS 1.

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