title: Ewing sarcoma versus osteomyelitis: differential diagnosis with magnetic resonance imaging.
abstract: OBJECTIVE
  To find and evaluate characteristic magnetic resonance imaging (MRI) patterns for the differentiation between Ewing sarcoma and osteomyelitis.
  
  
  METHODS
  We identified 28 consecutive patients referred to our department for MRI (1.5 T) of an unclear bone lesion with clinical symptoms suggestive of Ewing sarcoma or osteomyelitis. MRI scans were re-evaluated by two experienced radiologists, typical MR imaging features were documented and a diagnostic decision between Ewing sarcoma and osteomyelitis was made. Statistical significance of the association between MRI features and the biopsy-based diagnosis was assessed using Fisher's exact test.
  
  
  RESULTS
  The most clear-cut pattern for determining the correct diagnosis was the presence of a sharp and defined margin of the bone lesion, which was found in all patients with Ewing sarcoma, but in none of the patients with osteomyelitis (P < 0.0001). Contrast enhancing soft tissue was present in all cases with Ewing sarcoma and absent in 4 patients with osteomyelitis (P = 0.0103). Cortical destruction was found in all patients with Ewing sarcoma, 4 patients with osteomyelitis did not present any cortical reaction (P = 0.0103). Cystic or necrotic areas were identified in 13 patients with Ewing sarcoma and in 1 patient with osteomyelitis (P = 0.004). Interobserver reliability was very good (kappa = 1) in Ewing sarcoma and moderate (kappa = 0.6) in patients with osteomyelitis.
  
  
  CONCLUSIONS
  A sharp and defined margin, optimally visualized on T1-weighted images in comparison to short tau inversion recovery (STIR) images, is the most significant feature of Ewing sarcoma in differentiating from osteomyelitis.
authors.affiliation: Department of Radiology, Innsbruck Medical University, Anichstraße 35, 6020, Innsbruck, Austria. benjamin.henninger@i-med.ac.at
authors.forename: B
authors.initials: B
authors.lastname: Henninger
authors.forename: B
authors.initials: B
authors.lastname: Glodny
authors.forename: A
authors.initials: A
authors.lastname: Rudisch
authors.forename: T
authors.initials: T
authors.lastname: Trieb
authors.forename: A
authors.initials: A
authors.lastname: Loizides
authors.forename: D
authors.initials: D
authors.lastname: Putzer
authors.forename: W
authors.initials: W
authors.lastname: Judmaier
authors.forename: M F
authors.initials: MF
authors.lastname: Schocke
mesh_terms: D000293:Adolescent; D000328:Adult; D001859:Bone Neoplasms / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D015588:Observer Variation; D010019:Osteomyelitis / Q000473:pathology*; D015203:Reproducibility of Results; D012512:Sarcoma, Ewing / Q000473:pathology*; D012680:Sensitivity and Specificity; D055815:Young Adult