The role of imaging in differentiating low-grade and high-grade central chondral tumours

Highlights: • Management and prognosis of central chondrosarcoma depend on histological grade. • Lack of reliable histopathological criteria in the grading of chondrosarcoma. • Imaging assists in differentiating between low-grade and high-grade chondrosarcoma. • Radiography, magnetic resonance imaging and nuclear medicine may be helpful. • Accurate pre-operative diagnosis ultimately requires a multidisciplinary approach. Chondrosarcoma is a malignant cartilage matrix-producing tumour. Those arising de novo are called primary chondrosarcomas and are the second commonest primary malignant bone tumours. Numerous types of primary chondrosarcoma exist, namely conventional central (intramedullary), periosteal (juxta-cortical), clear cell, mesenchymal, and dedifferentiated. The biologic aggressiveness, prognosis and thus management of chondrosarcoma are dependent on the histological sub-type and grade. Accurate pre-operative diagnosis is therefore essential in determining management and outcome which requires a multidisciplinary approach taking into account clinical features, imaging findings and histopathology. In this review, we present the pertinent multimodality imaging features which aid in the differentiation of low-grade and high-grade conventional central chondrosarcoma.