<sup>99m</sup>Tc‐HMPAO‐leukocyte scintigraphy for diagnosis and therapy monitoring of skull base osteomyelitis

Rozenblum, Laura; Vérillaud, Benjamin; Paycha, F.; Vironneau, P.; Abulizi, Mukedaisi; Benada, A.; Cross, Tumatarii; El-Deeb, Ghada; Vodovar, Nicolas; Peretti, I.; Herman, Philippe; Sarda‐Mantel, Laure

doi:10.1002/lio2.159

Cited by 17 publications

(11 citation statements)

References 37 publications

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“…MRI or CT as single modality is insufficient to be crucial in diagnosing malignant otitis externa [24]. Technetium 99m scans may show osteoblastic activity that may be useful for therapeutic monitoring of SBO [25]. Hybrid technique PET–MRI or CT-MRI present complementary value that strengthens imaging modalities [24, 26].…”

Section: Discussionmentioning

confidence: 99%

“…Hybrid technique PET–MRI or CT-MRI present complementary value that strengthens imaging modalities [24, 26]. However, soft-tissue abnormalities in MRI over the mastoid area and/or in infratemporal fossa, or CT scan demonstrating the presence of bony destruction in mastoid area, and clinical manifestations of otitis allow initial diagnosis of malignant otitis externa [4, 8, 15, 21, 22, 24, 25]. In our study, CT scans revealed inflammatory process in the tympanic cavity with features of bony destruction of the mastoid process in one patient.…”

Section: Discussionmentioning

confidence: 99%

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Skull base osteomyelitis: factors implicating clinical outcome

et al. 2019

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Skull base osteomyelitis is a serious disease with a high risk of complications including neuroinfection. Typically, the inflammation of the skull base results from infection from neighboring tissues. In case of malignant otitis externa, inflammation disseminates from the external auditory canal. In this study, we present our experience with seven patients diagnosed with skull base osteomyelitis that began with otitis externa and have been treated in our department for the last 10 years. Department Patient Database was searched for the diagnosis skull base osteomyelitis. The search covered the last 10 years. The search revealed seven patients who met the above-described criteria. Medical records of those patients were carefully analyzed including age, gender, symptoms and signs, diagnostics details, treatment, performed procedures, number of hospitalization days, comorbid diseases, and complications including any cranial nerve palsy. Detailed analysis of medical records of patients included in this study showed that skull base osteomyelitis presents a challenge for diagnosis and treatment. Treatment strategy requires prolonged aggressive intravenous antibiotic therapy, and in some cases combined with surgical intervention. Cranial nerve paresis indicates progression of the disease and is associated with longer hospital stay. Similar relationship is observed in patients with skull base osteomyelitis that required surgery. Diabetes in patient’s medical history may complicate the healing process. Diabetes, neural involvement, and surgery may overlap each other resulting in longer hospital stay. Cranial nerve paresis may not resolve completely and some neural deficits become persistent.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Skull base osteomyelitis: factors implicating clinical outcome

et al. 2019

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“…Differentiation between both entities is crucial because they involve different treatment methods and planning. 12–15 The treatment of osteitis involves antibiotics alone, whereas osteomyelitis must be treated surgically with debridement and sequestrectomy. 27…”

Section: Discussionmentioning

confidence: 99%

“…10–12 Routine magnetic resonance imaging (MRI) and isotope studies are used for the prediction of skull base osteomyelitis, but their results are non-specific. 13–15 Diffusion-weighted imaging offers better characterisation of the soft tissues and their physiological processes because it reflects the random motion of the water protons, which is disturbed by the intracellular organelles and macromolecules located within the tissues. 16,17 Diffusion-weighted imaging is commonly used for the assessment of head and neck cancer, 17,18 soft tissue infection, 19,20 and bone infection with osteomyelitis.…”

Section: Introductionmentioning

confidence: 99%

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

Razek

Mahmoud

2020

J. Laryngol. Otol.

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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.

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“…A tagged white blood cell study can be used for confirming healing at the end of antibiotic therapy. 1,11,36 Overall, the literature has variable data regarding the overall diagnostic value of nuclear medicine studies. 37 A recent review of malignant otitis externa literature revealed pooled sensitivities for technetium-99 and gallium-67 of 85.1% and 71.2%, respectively, with poor specificity; however, the data were deemed insufficient for a meta-analysis.…”

Section: Pathologymentioning

confidence: 99%

Skull Base Osteomyelitis: A Comprehensive Imaging Review

Chapman

Choudhary

Singhal

2021

AJNR Am J Neuroradiol

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Skull base osteomyelitis is a relatively rare condition, generally occurring as a complication of advanced otologic or sinus infection in immunocompromised patients. Skull base osteomyelitis is generally divided into 2 broad categories: typical and atypical. Typical skull base osteomyelitis occurs secondary to uncontrolled infection of the temporal bone region, most often from necrotizing external otitis caused by Pseudomonas aeruginosa in a patient with diabetes. Atypical skull base osteomyelitis occurs in the absence of obvious temporal bone infection or external auditory canal infection. It may be secondary to advanced sinusitis or deep face infection or might occur in the absence of a known local source of infection. Atypical skull base osteomyelitis preferentially affects the central skull base and can be caused by bacterial or fungal infections. Clinically, typical skull base osteomyelitis presents with signs and symptoms of otitis externa or other temporal bone infection. Both typical and atypical forms can produce nonspecific symptoms including headache and fever, and progress to cranial neuropathies and meningitis. Early diagnosis can be difficult both clinically and radiologically, and the diagnosis is often delayed. Radiologic evaluation plays a critical role in the diagnosis of skull base osteomyelitis, with CT and MR imaging serving complementary roles. CT best demonstrates cortical and trabecular destruction of bone. MR imaging is best for determining the overall extent of disease and best demonstrates involvement of marrow space and extraosseous soft tissue. Nuclear medicine studies can also be contributory to diagnosis and follow-up. The goal of this article was to review the basic pathophysiology, clinical findings, and key radiologic features of skull base osteomyelitis. ABBREVIATIONS: ASBO ¼ atypical skull base osteomyelitis; EAC ¼ external auditory canal; Ga-67 ¼ gallium-67 citrate; IgG4 ¼ immunoglobulin G4; Tc99m MDP ¼ technetium Tc99m methylene diphosphonate; NEO ¼ necrotizing external otitis; SBO ¼ skull base osteomyelitis; TSBO ¼ typical skull base osteomyelitis S kull base osteomyelitis (SBO) is a rare, potentially life-threatening infection that can present a diagnostic challenge clinically and radiologically. [1][2][3][4] While reports differ in terminology, there are generally 2 categories of SBO: typical and atypical. Typical SBO (TSBO) is the most common and classically occurs in elderly patients with diabetes as a result of necrotizing external otitis (NEO) caused by Pseudomonas species. (Fig 1). 1,3 Atypical SBO (ASBO), also called central SBO, predominantly involves the basisphenoid and basiocciput and occurs without preceding otologic infection (Fig 2). 2,5 Recognition of SBO is increasing, and it is clear that radiologic evaluation plays a critical role in diagnosis and management. The goal of this article was to review the pathophysiology, clinical presentation, and detailed radiologic findings using multiple modalities including CT, MR imaging, and nuclear medicine.

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^99mTc‐HMPAO‐leukocyte scintigraphy for diagnosis and therapy monitoring of skull base osteomyelitis

Cited by 17 publications

References 37 publications

Skull base osteomyelitis: factors implicating clinical outcome

Skull base osteomyelitis: factors implicating clinical outcome

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

Skull Base Osteomyelitis: A Comprehensive Imaging Review

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