Mastoiditis WorkupIn cases of suspected mastoiditis, imaging is used to evaluate the findinsg of mastoid destruction and possible complications. The role of magnetic resonance mastoiditis ct scan findings MRI in mastoiditis has not been systematically evaluated. To assess the diagnostic performance of MRI in patients with suspected acute mastoiditis. Twenty-three patients with suspected acute mastoiditis were included in this retrospective study 15 boys, 8 girls; stanozolol ganhos age, 2 years 11 months. All patients were mastoiditis ct scan findings on a 1.
Magnetic resonance imaging in acute mastoiditis
In cases of suspected mastoiditis, imaging is used to evaluate the extent of mastoid destruction and possible complications. The role of magnetic resonance imaging MRI in mastoiditis has not been systematically evaluated. To assess the diagnostic performance of MRI in patients with suspected acute mastoiditis. Twenty-three patients with suspected acute mastoiditis were included in this retrospective study 15 boys, 8 girls; mean age, 2 years 11 months. All patients were examined on a 1.
Surgical findings, as well as clinical and imaging follow-up were used as the standard of reference. The sensitivity and accuracy of MRI for mastoiditis and subperiosteal abscesses was calculated.
Mastoiditis and subperiosteal abscesses were identified by MRI in all cases. Multiparametric MRI has high accuracy for mastoiditis and subperiosteal abscesses. Mastoiditis is usually caused by acute otitis media spreading from the ear to the mastoid.
Its incidence has greatly decreased since the introduction of antibiotics 1 , but it still presents a significant health problem because it may lead to potentially fatal complication 2. While initial diagnosis of acute mastoiditis is mostly based on clinical findings, computed tomography CT is often used to assess the extent of mastoiditis 3.
Magnetic resonance imaging MRI has an excellent soft tissue contrast and appears well suited to evaluate both the mastoid and possible complications of mastoiditis. The aim of this study was to assess the accuracy of MRI in patients with suspected mastoiditis. This retrospective study was approved by the local ethics committee and written informed consent was waived. The radiology information system RIS of our hospital was searched for patients who were referred for MRI with suspected mastoiditis between April and December Twenty-three patients with suspected mastoiditis were identified and included in the study 15 boys, 8 girls; age range, 8 months to 12 years 11 months; mean age, 2 years 11 months.
There were no cases with facial nerve symptoms. The time interval between the beginning of symptoms and the MR examination was in the range of 1—21 days median, 3 days. Ten patients also had a history of previous otitis media. MRI was performed on the day of admission to the hospital. The patients were examined in the supine position. Transverse dual echo turbo spin echo TSE images of the brain and skull base were acquired with: Acquisition time for the dual echo sequence was 4 min 12 s.
Transverse T1-weighted T1W images of the skull base were acquired with: Transverse diffusion-weighted echoplanar images DWI of the skull base were acquired with: DWIs were acquired with b-values of 0, , and Coronal time-of-flight images of the brain and skull base were acquired with: Transverse contrast-enhanced T1W TSE images of the skull base with fat saturation were acquired with: Coronal contrast-enhanced T1W TSE images of the skull base and brain with fat saturation were acquired with: Twenty patients were examined under general anesthesia, two patients under sedation, and one patient without medication.
Image evaluation was performed independently by two board-certified radiologists with 9 and 11 years of experience with head and neck MRI, respectively. In cases of differing findings, the final decision was met in consensus. Fluid accumulations, increased contrast enhancement of the mastoid, and restricted diffusion in the mastoid were interpreted as signs of mastoiditis.
Imaging findings were interpreted as mastoiditis when two or more of the criteria mentioned above were met. Subperiosteal fluid collections, extracranial contrast enhancement adjacent to the mastoid, and extracranial restricted diffusion adjacent to the mastoid were interpreted as a sign of a subperiosteal abscess.
Imaging findings were regarded as positive for subperiosteal abscess when two of the three criteria were met. Surgery findings were used as the standard of reference. The sensitivity and accuracy of MRI for mastoiditis and subperiosteal abscesses was calculated based on the standard of reference described above. Data were analyzed using MedCalc The remaining three patients included one case of cholesteatoma, one with otitis media, and one with a solid mass of the mastoid, which was proven to be a manifestation of acute lymphatic leukemia by mastoid biopsy.
An year-old boy with right-sided mastoiditis. A fluid accumulation with peripheral contrast enhancement and restricted diffusionis seen in the right mastoid white arrow. In contrast, the normal left mastoid is air-filled red arrow. MRI identified one case of thrombosis of the transverse and sigmoid sinus Fig. Furthermore, MRI detected an infratentorial epidural abscess Fig. A 2-year-old girl with right-sided mastoiditis and venous sinus thrombosis.
Fluid accumulation and increased contrast uptake in the right mastoid red arrow. Thrombus in the right transverse sinus white arrow. A 1-year-old boy with left-sided mastoiditis. A perisinus abscess white arrow is seen in a axial T2W and b axial T1W, contrast-enhanced fat saturation. The phase contrast angiography c demonstrates the compression of the sigmoid sinus caused by the perisinus abscess.
The coronal contrast-enhanced T1W image d demonstrates a subperiosteal abscess in the same patient red arrow. The results of the current study show that MRI has excellent accuracy for mastoiditis and concurrent subperiosteal abscesses. It also demonstrates the potential of MRI for assessing mastoiditis complications.
To our knowledge, no systematic evaluation of the accuracy of MR in suspected mastoiditis has been published previously. At first sight, our findings differ greatly from earlier works, which investigated the use of incidental MR findings for diagnosing mastoiditis. Based on our own clinical experience we fully agree that fluid retention in the mastoid is a common incidential finding of little clinical consequence, if signs of inflammation are otherwise absent.
In contrast, our results are based on multiparametric evaluation, as T2W, T1W images with without contrast enhancement, and DWI were used. Our choice of imaging protocol is influenced by previous studies, which has demonstrated the usefulness of both DWI 6 and contrast media 7 — 9 for diagnosing pyogenic infection. While gadobutrol is approved for use in adults and children aged 2 years and older, we used gadobutrol for all patients included in the study, including 13 patients younger than 2 years, because of the potentially life-threatening nature of possible intracranial complications of mastoiditis and because of previous experience with contrast agents in infectious disease.
These studies retrospectively evaluated patients who received MRI of the skull and the skull base, regardless of symptoms. On the other hand, only patients with clinically suspected mastoiditis were included in our study. The specificity of MRI is limited by the fact that fluid collections in the mastoid cells are not necessarily pathological and that contrast enhancement of the mucosal lining of mastoid cell may be caused by hyperemia due to otitis media, even if the mastoid is not infected.
However, the estimate of specificity is based on just three patients who did not have mastoiditis. The assessment of specificity is limited by the preselection of patients based on clinical criteria, as most patients without clinical signs of mastoiditis do not receive an MRI scan. A larger sample would be needed for more accurate assessment of specificity. While CT is often used for imaging suspected mastoiditis, a comprehensive evaluation of the accuracy of CT in mastoiditis is lacking.
These differences may be caused by differing inclusion criteria used in the studies. While the logistical challenges presented by pediatric emergency MRI are considerable, MRI in suspected mastoiditis also has considerable potential advantages. Besides the high accuracy demonstrated in the current study, these also include absence of radiation exposure and better sensitivity for the detection of brain abscesses in comparison to CT The current study has several limitations.
Above all, no comparison with CT, which is routinely used for imaging in cases of suspected mastoiditis by many centers, is available. In MRI, the diagnosis of mastoiditis is based on signs of pyogenic infection and thus coalescent mastoiditis, i.
However, MRI is not suited for evaluation of small bony structures like the mastoid septa, whose destruction is an important sign of mastoiditis on CT. This may be a disadvantage of MRI in less pronounced cases of mastoiditis. The use of an echo-planar sequence for DWI can also be considered a limitation. Several authors recommend the use of turbo spin echo diffusion-weighted sequences instead of echo-planar sequences for evaluation of the mastoid because they show fewer susceptibility artifacts 12 , One patient did not receive surgical treatment or biopsy and thus no surgical proof for the presence or absence of mastoiditis was available.
In this case, diagnosis was based on clinical and imaging follow-up, which is however presumed to be less reliable than surgical findings. The frequency of intracranial complications observed in the current study is low, and because of the relatively low overall number of patients the study is not suited for a conclusive evaluation of such complications.
In conclusion, multiparametric MRI has high sensitivity and diagnostic accuracy in suspected mastoiditis.
National Center for Biotechnology Information , U. Acta Radiol Short Rep. Published online Feb Received Dec 2; Accepted Jan This article has been cited by other articles in PMC. Abstract Background In cases of suspected mastoiditis, imaging is used to evaluate the extent of mastoid destruction and possible complications. Purpose To assess the diagnostic performance of MRI in patients with suspected acute mastoiditis.
Material and Methods Twenty-three patients with suspected acute mastoiditis were included in this retrospective study 15 boys, 8 girls; mean age, 2 years 11 months. Conclusion Multiparametric MRI has high accuracy for mastoiditis and subperiosteal abscesses. Mastoiditis, infection, magnetic resonance imaging MRI , children. Introduction Mastoiditis is usually caused by acute otitis media spreading from the ear to the mastoid. Material and Methods This retrospective study was approved by the local ethics committee and written informed consent was waived.
MRI All patients were examined on a 1. Image evaluation and standard of reference Image evaluation was performed independently by two board-certified radiologists with 9 and 11 years of experience with head and neck MRI, respectively.
Statistical analysis The sensitivity and accuracy of MRI for mastoiditis and subperiosteal abscesses was calculated based on the standard of reference described above. Open in a separate window.
Discussion The results of the current study show that MRI has excellent accuracy for mastoiditis and concurrent subperiosteal abscesses.