Iodine-123 metaiodobenzylguanidine (MIBG) has been used as a diagnostic agent for imaging neural crest tumours. In a retrospective study of 27 patients, the role of 123I MIBG scintigraphy and X-ray computed tomography (CT) for detection of disease was compared. Both imaging techniques were accurate in the identification of these tumours. Iodine-123 MIBG was slightly more accurate in detecting metastatic disease. Computed tomography of tumours was useful in planning appropriate metastatic intervention. We suggest 123I MIBG should be the primary imaging procedure followed by CT in the investigation of these patients.