Imaging of ewing sarcoma: an updated analysis including presenting features, prognostic imaging biomarkers, and treatment response assessment

F-FDG PET/CT enable sensitive detection of metastatic disease, with PET providing metabolic biomarkers correlated with prognosis and chemotherapy response. Imaging features, including tumor volume, diffusion metrics, and changes in contrast enhancement, increasingly allow non-invasive prediction of histologic response, a key determinant of survival. Lastly, recent quantitative methods, such as radiomics and artificial intelligence, show promise for differentiating Ewing sarcoma from other sarcomas, predicting metastases, and anticipating local recurrence. By reviewing modality-specific findings, staging strategies, and response assessment tools, this article provides a practical, updated, structured framework for radiologists and oncologists to optimize diagnosis, risk stratification, and treatment planning in Ewing sarcoma, ultimately improving patient care.