# Beyond Chordoma: A Comprehensive Review of Sacral Lesions

## TL;DR

This paper reviews various types of sacral lesions, focusing on imaging features and diagnostic challenges to improve accurate diagnosis and patient care.

## Contribution

The paper offers a structured, updated diagnostic approach for sacral lesions, emphasizing imaging and clinical implications.

## Key findings

- Sacral lesions include benign, malignant, and non-neoplastic conditions with overlapping imaging features.
- Accurate diagnosis often requires image-guided biopsy due to diagnostic challenges in imaging alone.
- Familiarity with sacral pathologies is crucial for effective radiological and multidisciplinary management.

## Abstract

The sacrum is a common site for a wide range of pathological processes, including benign and malignant tumors as well as non-neoplastic conditions. This comprehensive review provides an updated and structured overview of the full spectrum of sacral lesions, with emphasis on imaging features and diagnostic pitfalls. Our review also integrates a systematic diagnostic approach designed to support accurate characterization and multidisciplinary management of these complex lesions.

The sacrum is a common site for a wide range of pathological processes, including benign and malignant tumors as well as non-neoplastic conditions. Accurate diagnosis of sacral lesions remains challenging due to overlapping imaging features and the anatomical complexity of the region. This review provides a comprehensive overview of sacral lesions, with emphasis on imaging characteristics, diagnostic challenges, and clinical implications. Key imaging findings are highlighted to help narrow the differential diagnosis. While certain imaging patterns may suggest specific etiologies, image-guided biopsy is often necessary for definitive diagnosis. Familiarity with the spectrum of sacral pathologies is essential for radiologists to effectively contribute to diagnosis, patient management, and multidisciplinary care.