• Sarah Kalus and Asif Saifuddin.
• The Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK. sarahkalus@gmail.com.
• Eur Radiol. 2019 Oct 1; 29 (10): 5700-5708.

ObjectiveTo compare whole-body MRI (WB-MRI) at 1.5/3T and bone scintigraphy in the skeletal staging of Ewing sarcoma (ES) of bone.MethodsAll patients with a histological diagnosis of ES of bone between 2007 and 2018 were retrospectively reviewed. The analysis included gender, mean age, skeletal distribution, and prevalence of skeletal metastases on WB-MRI and bone scintigraphy.ResultsThe study group comprised 182 patients with a mean age of 18.0 years (range 2-56 years), 126 males and 56 females. Skeletal metastases were detected overall in 30 patients (16.5%), in 23 of 96 patients (24%) who underwent WB-MRI, and in 20 of 118 patients (16.9%) who underwent bone scintigraphy. Of 71 patients who underwent both WB-MRI and bone scintigraphy, skeletal metastases were detected on both modalities in 13 (18.3%), while in 4 patients, skeletal metastases were identified on WB-MRI alone. There were no patients in whom skeletal metastases were identified on bone scintigraphy alone. Of 13 patients with skeletal metastases who underwent both studies, WB-MRI showed a greater number of metastatic foci in 10 (76.9%). However, scintigraphy was superior to WB-MRI in detecting skull vault lesions, but did show false-positive results around the long bone growth plates.ConclusionWB-MRI is more sensitive than bone scintigraphy in detecting skeletal metastases in ES of bone, with the exception of skull vault metastases. Consideration should be given to replacing bone scintigraphy with WB-MRI.Key Points• Whole-body MRI is more sensitive than bone scintigraphy in detecting skeletal metastases in Ewing sarcoma of bone. • Whole-body MRI can safely replace bone scintigraphy for staging of the skeleton, with the acknowledgement of the possibility of missing a clinically occult skull vault metastasis.

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