Central skull base osteomyelitis as a complication of necrotizing otitis externa: Imaging findings, complications, and challenges of diagnosis

Adams, Andrew A.; Offiah, Curtis

doi:10.1016/j.crad.2012.02.004

Cited by 79 publications

(96 citation statements)

References 19 publications

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“…T specificity, ver urs is encounte raphics and Com tient is 69 year ickness. Yet, th ce of fibrous dy y skull neoplasm hich have a pr w growing [12] pending on the nsity [14] . The in detecting m end, based on th ology.…”

Section: Discussionmentioning

confidence: 99%

Characterization of a parietal lesion detected by diffusion weighted MRI, NaF18-PET/CT and CT

Win

Aparici

2013

JBGC

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It is very important to accurately characterize skull lesions so that appropriate treatment decisions can be made. False positive readings may lead to unnecessary surgical intervention or radiation. We present a case of a parietal lesion seen on Diffusion weighted (DW) MRI, and further characterized with NaF18-PET/CT and CT in a 69 year old male. This is the first case to report the use of DW MRI, NaF18-PET/CT bone scan and CT in the diagnosis of a skull lesion. DW MRI is known to have high specificity to detect malignant lesions in the skull. If a similar case such as ours in encountered in everyday clinical practice, a differential diagnosis of a benign etiology should be considered.

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Section: Discussionmentioning

confidence: 99%

Characterization of a parietal lesion detected by diffusion weighted MRI, NaF18-PET/CT and CT

Win

Aparici

2013

JBGC

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“…However, CT scanning has limitations. First, CT evidence of osteolysis is a common finding but it can be associated with various tumors and congenital lesions of the skull base [2]. Hence CT cannot always provide a distinction between inflammatory and neoplastic processes.…”

Section: Discussionmentioning

confidence: 99%

“…NOE occurs primarily in diabetic elderly patients with a male preponderance [2]. Typically due to pseudomonas aeruginosa, NOE begins as a soft tissue infection of the external auditory canal (EAC) and spreads via the fissures of Santorini and the tympanomastoid suture to involve the cranial base [3].…”

Section: Introductionmentioning

confidence: 99%

“…Otological examination may reveal oedema of the EAC and the presence of granulation tissue [5]. Prompt intravenous antibiotic treatment is required until there is resolution of symptoms and return of the EAC to normal [2].The diagnosis is based on a combination of clinical, laboratory and image findings. With absence of single definite diagnostic criteria, the diagnosis is often delayed [1].…”

Section: Introductionmentioning

confidence: 99%

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Single Photon Emission Computed Tomography/Computed Tomography (SPECT/CT) of the Skull in Necrotizing Otitis Externa: Comparison with Planar Bone Scintigraphy, SPECT and CT

Yeddes¹

2017

JOENTR

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Purpose: Assess the diagnostic performance of single photon emission tomography/computed tomography (SPECT/CT) for identifying necrotizing otitis externa (NOE) and compare this technique with planar bone scintigraphy (BS), SPECT and CT. Methods:Data from 13 patients with suspected NOE were retrospectively studied. Planar BS and SPECT images were interpreted by nuclear medicine physician, CT images by radiologist and SPECT/CT images by both nuclear medicine physician and radiologist. Planar BS, SPECT and SPECT/CT images were taken as positive in the presence of increased skull base uptake and CT images in the presence of periosteal reaction and bone lysis. Clinical evolution, imaging results, microbiology and histopathology were taken into consideration to determine the final diagnosis. Sensitivity, specificity, and predictive values, were calculated for each technique. The McNemar's test chi-squared with Yates correction of 0.5 was used to compare sensitivities and specificities.Results: SPECT/CT had the highest sensitivity (100%), followed by SPECT (90%), planar BS (80%) and CT (60%). Specificity was 100% for all imaging modalities since all reported positive cases were identified as NOE in the final diagnosis. No statistically significant difference was noted when comparing SPECT/CT with planar BS, SPECT and CT. However, borderline statistical significance was found between SPECT/CT and CT (p-value=0.08). SPECT/CT was the best imaging modalities in the accurate location of sites of osteomyelitis. Conclusion:SPECT/CT showed high sensitivity and specificity in the diagnosis of NOE, but was not statistically superior to planar BS, CT or SPECT in this small patient population. Keywords:

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“…19 Given that neither test is diagnostic, most studies recommend a CT and MRI together in order to obtain as much information as possible. 13,16,17,20 Another imaging option is a radionucleotide scan, including 99m Tc or gallium-67 bone scans. Though not standard practice at present, these imaging modalities have some advantages over CT and MRI.…”

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confidence: 99%

Are CT and MRI Scanning Reliable in Diagnosing Otogenic Skull Base Osteomyelitis in Non-Immunocompromised Elderly Patients? A Case Series and Review of the Literature

Lim

Shaw

2017

IJRRT

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Background: Otogenic skull base osteomyelitis (SBO) is a life-threatening condition that requires timely diagnosis and treatment. It is most commonly seen in the elderly diabetic or immunocompromised patients. The role of nuclear medicine imaging in diagnosis of SBO remains controversial.Methods: This paper presents two unusual cases of otogenic SBO in elderly nonimmunocompromised patients. A review of the relevant literature from 1986 to 2016 was performed via the Medline database using search terms 'skull base osteomyelitis', 'otogenic', 'malignant otitis externa' and 'imaging'.Results: Both patients presented with chronic mild otalgia and ear discharge, and were subsequently diagnosed with otogenic SBO based on nuclear medicine imaging. Nuclear medicine imaging was essential for diagnosis and localization of SBO in both patients as CT and MRI either failed to detect or accurately localize SBO. Conclusion: SBO can occur in non-immunocompromised elderly patients with normal CT and MRI scans. Nuclear medicine imaging is essential in the diagnostic workup.Keywords: skull base osteomyelitis, nuclear medicine, bone scan, computed tomography, magnetic resonance imaging, otogenic, single-photon emission computed tomography

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Central skull base osteomyelitis as a complication of necrotizing otitis externa: Imaging findings, complications, and challenges of diagnosis

Cited by 79 publications

References 19 publications

Characterization of a parietal lesion detected by diffusion weighted MRI, NaF18-PET/CT and CT

Characterization of a parietal lesion detected by diffusion weighted MRI, NaF18-PET/CT and CT

Single Photon Emission Computed Tomography/Computed Tomography (SPECT/CT) of the Skull in Necrotizing Otitis Externa: Comparison with Planar Bone Scintigraphy, SPECT and CT

Are CT and MRI Scanning Reliable in Diagnosing Otogenic Skull Base Osteomyelitis in Non-Immunocompromised Elderly Patients? A Case Series and Review of the Literature

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