For the initial assessment of suspected Ewing sarcoma, the most effective imaging modalities include plain X-ray and MRI. A plain X-ray is typically the first imaging test performed to identify bone abnormalities suggestive of bone sarcoma, including Ewing sarcoma. If the X-ray suggests the possibility of bone sarcoma, urgent referral for specialist assessment is recommended. MRI is then used to further evaluate the extent of the lesion and soft tissue involvement, providing detailed anatomical information essential for diagnosis and treatment planning.
Ultrasound may be used if a soft tissue sarcoma is suspected, but for bone sarcoma such as Ewing sarcoma, X-ray followed by MRI is the standard approach.
CT scans can be used adjunctively to assess bone destruction and for surgical planning but are not the primary initial imaging modality.
Therefore, the initial imaging pathway for suspected Ewing sarcoma is plain X-ray followed by MRI for detailed assessment, with urgent referral for specialist evaluation if bone sarcoma is suspected on imaging.
NICE NG12