Primary malignant bone tumors are fairly rare. The most common primary malignant bone tumors are osteosarcoma, chondrosarcoma, and Ewing's sarcoma. Staging of the disease is necessary for determination of the treatment plan as well as follow-up of the lesion and its response to therapy. This depends on complete imaging and histopathological confirmation of the suspected entity. Diagnostic imaging has a master role in evaluation and management of bone cancers. Standard imaging modalities as conventional radiography, computed tomography (CT) scanning, magnetic resonance imaging (MRI) and skeletal scintigraphy cannot reach the accurate staging of the tumor as they depend mainly on morphologic diagnostic criteria and cannot differentiate between post-treatment changes and recurrence or residual tumor due to distortion of the regional anatomy by surgery and/or radiation. Also, positron emission tomography (PET) is limited in this field as it depends only on functional imaging through localization of metabolic activity using various radiopharmaceutical agents with lack of anatomical localization. Viable malignant primary bone tumors are usually 18F-fluorodeoxyglucose (FDG) avid. Accumulation of FDG may reflect tumor characteristics based on its metabolic activity providing better characterization of indeterminate lesions and guidance of targeted biopsy of the most metabolically active area within larger tumors especially tumors of mixed grade and/or cell type.