Central cartilage tumours of bone range from the benign enchondroma to the malignant chondrosarcoma. They are an incidental finding in up to 2.8% of routine magnetic resonance imaging (MRI) examinations performed of the shoulder and knee. The purpose of this review is to provide a current appraisal of the imaging and histological challenges of distinguishing enchondroma from low-grade chondrosarcoma. The general radiologist, encountering these lesions in the proximal humerus and around the knee, is introduced to the Birmingham Atypical Cartilage Tumour Imaging Protocol (BACTIP). This provides a guide to the initial assessment and diagnosis, a stepwise imaging follow-up plan, and the indications for onward specialist orthopaedic oncology referral or discharge from follow-up.
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