Diffusion-weighted Magnetic Resonance Imaging as a Novel Imaging Modality in Assessing Treatment Response in Necrotizing Otitis Externa

Cherko, Matthew; Nash, Robert; Singh, Arvind; Lingam, Ravi Kumar

doi:10.1097/mao.0000000000001022

Cited by 19 publications

(15 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Improved imaging technology means that MRI can be used to assess for disease resolution, and recent literature has highlighted the benefits of diffusion-weighted MRI in assessing for disease resolution when compared to standard MRI sequences [8] . Indeed all of our necrotizing otitis externa patients post-protocol now receive an MRI with contrast as well as diffusion weighted imaging, and this is demonstrated by our data which show that prior to the protocol this was not always the case.…”

Section: Discussionmentioning

confidence: 99%

“…In terms of imaging, there is some literature to suggest that CT scans can only detect disease when at least 30%-50% of bone erosion has already occurred [5] . However, our use of both CT and MRI allows imaging to be more sensitive, and the use of diffusion-weighted MRI aids to assess disease progression [8] . MRI is useful at the initial presentation to give a baseline level of inflammation, which can then be compared with subsequent scans to demonstrate progression of the disease.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Management of Necrotizing Otitis Externa: Our Experience with Forty-Three Patients

2017

Self Cite

View full text Add to dashboard Cite

OBJECTIVE:To assess the impact of the introduction of a dedicated management protocol of necrotizing otitis externa patients with joint care between otorhinolaryngology and infectious diseases. MATERIALS and METHODS:Retrospective review of case notes and the otorhinolaryngology department database of all adults admitted with necrotizing otitis externa at our teaching hospital over a 5-year period. The patients were split into two groups (first group of 10 patients prior to the introduction of the dedicated management protocol, and a second group of 33 patients managed after the introduction of this protocol). RESULTS:Of the 43 patients included in the study, diabetes mellitus was present in 83.7%. Pseudomonas aeruginosa was grown in 67.4% of patients. All 43 patients underwent computed tomography and magnetic resonance imaging (with contrast) scans. Surgical intervention was undertaken in 25.6% of patients. Mean follow-up was 10 months (SD, ±7 months). Of the 43 patients, 79.1% made a full recovery and were discharged. Relapse occurred in 9.3% of patients. One patient died because of a myocardial infarction 4 months after treatment. The mean length of stay was significantly lower after the protocol was introduced (25.6±5.3 vs. 14.2±3.8 days, p=0.001), and the duration of treatment was also significantly lower after the protocol (21.2±6.8 vs. 14.3±4.3 weeks, p=0.01). CONCLUSION:The introduction of a dedicated management protocol and joint care with otorhinolaryngology and infectious diseases resulted in improved care and decreased length of stay in patients. Early diagnosis and involvement with the relevant teams as well as prompt intervention are the key factors that reduce morbidity and mortality.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Management of Necrotizing Otitis Externa: Our Experience with Forty-Three Patients

2017

Self Cite

View full text Add to dashboard Cite

show abstract

“…Only one study has discussed the role of diffusion-weighted imaging in the follow up of patients with necrotising otitis externa. 26 To our knowledge, no previous study in the English literature has investigated the role of diffusion-weighted imaging for predicting skull base osteomyelitis in necrotising otitis externa patients. This work aimed to predict skull base osteomyelitis in patients with necrotising otitis externa using diffusion-weighted imaging.…”

Section: Introductionmentioning

confidence: 99%

Prediction of skull base osteomyelitis in necrotising otitis externa with diffusion-weighted imaging

Razek

Mahmoud

2020

J. Laryngol. Otol.

View full text Add to dashboard Cite

ObjectiveTo predict skull base osteomyelitis in patients with necrotising otitis externa using diffusion-weighted imaging.MethodsA retrospective analysis was conducted of 25 necrotising otitis externa patients with skull base osteomyelitis (n = 10) or without skull base involvement (n = 14) who underwent a single-shot diffusion-weighted imaging of the skull base.ResultsThe respective mean apparent diffusion coefficient values of the skull base, as determined by two reviewers, were 0.851 ± 0.15 and 0.841 ± 0.14 ×10-3mm2/s for the skull base osteomyelitis patients, and 1.065 ± 0.19 and 1.045 ± 0.20 ×10-3mm2/s for the necrotising otitis externa patients without skull base involvement. The difference in apparent diffusion coefficients between the groups was significant, for both reviewers (p = 0.008 and 0.012). The optimal threshold apparent diffusion coefficient for predicting skull base osteomyelitis in necrotising otitis externa patients was 0.945 ×10-3mm2/s and 0.915 ×10-3mm2/s, with an area under the curve of 0.825 and 0.800, accuracy of 87.5 and 83.3 per cent, sensitivity of 85.7 and 90.0 per cent, and specificity of 90.0 and 78.6 per cent, for each reviewer respectively.ConclusionApparent diffusion coefficient is a non-invasive imaging parameter useful for predicting skull base osteomyelitis in necrotising otitis externa patients.

show abstract

“…12,13 Diffusion-weighted imaging is used for the evaluation of head and neck cancer pre- and post-therapy, 12–16 and has a role in the examination of external ear diseases. 17,18…”

Section: Introductionmentioning

confidence: 99%

Reliability of diffusion-weighted magnetic resonance imaging in differentiation of recurrent cholesteatoma and granulation tissue after intact canal wall mastoidectomy

Razek

Ashraf

et al. 2019

J. Laryngol. Otol.

View full text Add to dashboard Cite

ObjectiveTo assess the reliability of diffusion-weighted magnetic resonance imaging in differentiating recurrent cholesteatoma from granulation tissue after intact canal wall mastoidectomy.MethodsA prospective study was conducted of 56 consecutive patients with suspected cholesteatoma recurrence after intact canal wall mastoidectomy who underwent diffusion-weighted imaging and delayed contrast magnetic resonance imaging of the temporal bone. The final diagnosis was recurrence in 38 patients and granulation tissue in 18 patients.ResultsCholesteatoma detection on diffusion-weighted imaging based on two sets of readings had sensitivity of 94.7 and 94.7 per cent, specificity of 94.4 and 88.9 per cent, and accuracy of 94.6 and 92.8 per cent, with good intra-observer agreement (Κ = 0.72, p = 0.001). Cholesteatoma detection on delayed contrast magnetic resonance imaging had sensitivity of 81.6 and 78.9 per cent, specificity of 77.8 and 66.7 per cent, and accuracy of 80.4 and 75.0 per cent, with fair intra-observer agreement (Κ = 0.57, p = 0.001). The mean cholesteatoma diameter on diffusion-weighted imaging was 7.7 ± 1.8 and 7.9 ± 1.8 mm, with excellent intra-observer agreement (Κ = 0.994, p = 0.001).ConclusionDiffusion-weighted imaging is a reliable method for differentiating recurrent cholesteatoma and granulation tissue after intact canal wall mastoidectomy.

show abstract

Diffusion-weighted Magnetic Resonance Imaging as a Novel Imaging Modality in Assessing Treatment Response in Necrotizing Otitis Externa

Cited by 19 publications

References 10 publications

Management of Necrotizing Otitis Externa: Our Experience with Forty-Three Patients

Management of Necrotizing Otitis Externa: Our Experience with Forty-Three Patients

Prediction of skull base osteomyelitis in necrotising otitis externa with diffusion-weighted imaging

Reliability of diffusion-weighted magnetic resonance imaging in differentiation of recurrent cholesteatoma and granulation tissue after intact canal wall mastoidectomy

Contact Info

Product

Resources

About