The challenging diagnosis and follow-up of skull base osteomyelitis in clinical practice

Abstract

Purpose The disease activity of skull base osteomyelitis can be challenging to assess by means of conventional imaging methods and renders monitoring of the disease difficult, especially in areas with restricted access to nuclear medicine imaging. Here, we provide clinically relevant data on the management of skull base osteomyelitis including assessment, treatment, and follow-up strategies with regards to the role of imaging. Method A chart review was performed including 30 patients treated for SBO from 1993 to 2015. Clinical findings, treatment procedures, and complication rates were assessed. Special attention was paid to imaging procedures. Results The overall mortality rate was 36.7% and increased to 45% when cranial nerve palsies were present. An initial computed tomography (CT) scan was performed in all patients, MRI in 60% and nuclear imaging in 33%. CT scans failed to detect progression or regression in up to 80% after four to nine months. MRI examinations could reveal changes at a higher rate compared to CT. Nuclear medicine functional imaging was most likely to assess disease activity. Conclusion A combination of different imaging modalities is recommended for diagnosing SBO. For the follow-up, MRI is preferable to CT as changes can be detected more readily with MRI. If available, nuclear medicine imaging should guide the decision of treatment discontinuation.

Diagnosing necrotizing external otitis on CT and MRI: assessment of pattern of extension

“…At the moment, the duration of antibiotic treatment is mainly determined by the otolaryngologist via clinical symptoms and imaging findings. However, as previously mentioned, an additional role may be found in nuclear medicine for follow-up of NEO disease extent and activity [ 10 , 11 ]. Hopefully, future research findings may guide clinicians in the optimal decision for treatment duration and follow-up.…”

“…However, functional assessment can be performed by a range of modalities, such as skeletal scintigraphy with single-photon emission computed tomography (SPECT), FDG—positron emission tomography (PET), PET combined with CT or MRI, and even leucocyte labelling. At the moment, nuclear imaging is mainly used for monitoring therapy effect, but the optimal nuclear diagnostic method for the evaluation of NEO disease extent and follow-up is unclear [ 11 ].…”

Predictive value of radiologic studies for malignant otitis externa: a systematic review and meta-analysis

“…Therefore, the specificity, diagnostic odds ratio, and area under the summary receiver operating characteristic curve could not be assessed. The sensitivity values obtained from diagnostic technetium-99m, 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 gallium-67, 9 , 10 , 17 , 22 , 25 , 27 , 28 , 29 , 30 , 31 MRI, 24 , 26 , 28 , 32 , 33 , 34 and CT 1 , 7 , 15 , 16 , 17 , 18 , 19 , 20 , 23 , 24 , 25 , 26 , 27 , 28 , 30 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 assessments were analyzed. The qua...…”

Skull Base Osteomyelitis and Long Term Outcome

“…Nadir görülen görülen KTO'nin yüksek morbidite ve mortalite oranı, doğru antibiyotik ve cerrahi tedavi yaklaşımlarıyla değiştirilebilir. Daha önce yayımlanmış olgu serilerinde olduğu gibi çalışmamızda KTO olguları sıklıkla otojenik kaynaklı (%81) ve yaşlı erkeklerde oluşmaktaydı; en sık risk faktörü hastaların % 87.5'inde tanımlanan diabetes mellitustu (10,11). Literatürde bildirilen otojenik kaynaklı KTO olgu-larında olduğu gibi hastalarda en sık baş ve/veya kulak ağrısının yanı sıra kulak akıntısı şikayeti vardı ve en çok VII.…”

“…Kafa çifti tutulumları bazı olgularda ilk bulgu olarak saptanabilirken sıklıkla hastalığın progresyonuna işaret etmektedir (9,14). Kafa çiftlerinin etkilenmesi kötü prognozla ilişkilendiren çalışmalar olduğu gibi, etkisi olmadığını gösterenler de bulunmaktadır (11,12,14). Yedinci sinir en sık ve ilk tutulan kafa çifti olup, aynı zamanda en geç düzelen veya kalıcı hasar bırakan kafa çifti tutulumudur.…”