Alice B Auinger1, Valerie Dahm1, Isabella Stanisz1, Ursula Schwarz-Nemec2, Christoph Arnoldner3. 1. Department of Otorhinolaryngology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria. 2. Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria. 3. Department of Otorhinolaryngology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria. christoph.arnoldner@meduniwien.ac.at.
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.
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.
Authors: Vanessa S Rothholtz; Alice D Lee; Bahman Shamloo; Mohsen Bazargan; Deya Pan; Hamid R Djalilian Journal: Laryngoscope Date: 2008-11 Impact factor: 3.325
Authors: Stewart Lee; Robin Hooper; Andrew Fuller; Alla Turlakow; Vincent Cousins; Reza Nouraei Journal: Otol Neurotol Date: 2008-08 Impact factor: 2.311
Authors: Wilhelmina L van der Meer; Jérôme J Waterval; Henricus P M Kunst; Cristina Mitea; Sjoert A H Pegge; Alida A Postma Journal: Eur Arch Otorhinolaryngol Date: 2021-04-25 Impact factor: 2.503