Between June 8, 1985 and January 29, 1986, the authors performed five CT-guided needle biopsies of suspicious sacral lesions. In each of the five cases, these biopsies allowed the acquisition of specimens suitable for definitive pathologic diagnosis. Three cases of metastatic adenocarcinoma, one case of desmoplastic fibroma, and one case of chronic inflammatory changes were noted. In the case involving chronic inflammatory changes, subsequent open biopsy was performed, confirming the inflammatory changes and absence of neoplasm. The authors conclude that percutaneous CT-guided biopsy of sacral lesion can be performed safely and rapidly, and allows accurate diagnosis and treatment of sacral lesions.