Comparison of MR imaging findings in paediatric and adult patients with acute mastoiditis and incidental intramastoid bright signal on T2-weighted images

Saat, Riste; Mahmood, Gulrez; Laulajainen‐Hongisto, Anu; Lempinen, Laura; Aarnisalo, Antti A.; Jero, Jussi; Markkola, Annamari

doi:10.1007/s00330-015-4113-5

Cited by 7 publications

(14 citation statements)

References 23 publications

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“…In a study comparing 35 adults and pediatric patients with clinical acute mastoiditis and 34 age‐matched controls, acute mastoiditis usually demonstrated hypointense to CSF intramastoid T2‐weighted signal intensity and diffusion restriction and intense intramastoid enhancement were absent in incidental mastoid effusion . Intramastoid T2‐hyperintensity alone is not a reliable sign for acute mastoiditis.…”

Section: Expert Opinionmentioning

confidence: 99%

Incidental Findings and Normal Anatomical Variants on MRI of the Brain in Adults for Primary Headaches

Evans

2017

Headache

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Section: Expert Opinionmentioning

confidence: 99%

Incidental Findings and Normal Anatomical Variants on MRI of the Brain in Adults for Primary Headaches

Evans

2017

Headache

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“…Recent studies have evaluated the use of MRI not only for showing intracranial complications of AM (epidural and subdural abscess, pachymeningitis and leptomeningitis, dural venous sinus thrombosis) but also for identifying signs of infection inside the temporal bone itself, including bone destruction [17][18][19]. In the context of AM, bone usually becomes visible on MRI due to the intramastoid mucosal swelling and inflammatory secretions that replace the air and provide highly intense background for the signal-void bony structures on T2-weighted images [17].…”

Section: Introductionmentioning

confidence: 99%

Detection of Coalescent Acute Mastoiditis on MRI in Comparison with CT

et al. 2020

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Purpose Current imaging standard for acute mastoiditis (AM) is contrast-enhanced computed tomography (CT), revealing inflammation-induced bone destruction, whereas magnetic resonance imaging (MRI) outperforms CT in detecting intracranial infection. Our aim was to compare the diagnostic performance of MRI with CT in detecting coalescent AM and see to which extent MRI alone would suffice to diagnose or rule out this condition. Methods The MR images of 32 patients with AM were retrospectively analyzed. Bone destruction was evaluated from T2 turbo spin echo (TSE) and T1 Gd magnetization-prepared rapid acquisition with gradient echo (MPRAGE) images. Intramastoid enhancement and diffusion restriction were evaluated subjectively and intramastoid apparent diffusion coefficient (ADC) values were measured. The MRI findings were compared with contrast-enhanced CT findings of the same patients within 48 h of the MR scan. Results Depending on the anatomical subsite, MRI detected definite bone defects with a sensitivity of 100% and a specificity of 54–82%. Exception was the inner cortical table where sensitivity was only 14% and specificity was 76%. Sensitivity for general coalescent mastoiditis remained 100% due to multiple coexisting lesions. The absence of intense enhancement and non-restricted diffusion had a high negative predictive value for coalescent mastoiditis: an intramastoid ADC above 1.2 × 10−3 mm2/s excluded coalescent mastoiditis with a negative predictive value of 92%. Conclusion The MRI did not miss coalescent mastoiditis but was inferior to CT in direct estimation of bone defects. When enhancement and diffusion characteristics are also considered, MRI enables dividing patients into low, intermediate and high-risk categories with respect to coalescent mastoiditis, where only the intermediate risk group is likely to benefit from additional CT.

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“…Saat et al . retrospectively analysed MRI images of: 35 adult and paediatric patients with clinically acute mastoiditis, and 34 consecutive age-matched controls without relevant middle-ear pathology and with incidental T2-hyperintensity that covered 50 per cent or more of the mastoid 9 . That paper reported that intramastoid T2-hyperintensity alone is not a reliable sign for acute mastoiditis.…”

Section: Discussionmentioning

confidence: 99%

“…That paper reported that intramastoid T2-hyperintensity alone is not a reliable sign for acute mastoiditis. The authors found that in acute mastoiditis, intramastoid T2-weighted signal intensity is usually hypointense to cerebrospinal fluid, whereas there is an absence of diffusion restriction and intense intramastoid enhancement in incidental mastoid effusion 9 …”

Section: Discussionmentioning

confidence: 99%

Incidental mastoiditis on magnetic resonance imaging scans: clinical relevance and cost implications

et al. 2018

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ObjectivesTo determine: (1) the incidence of incidental ‘mastoiditis’ reported on magnetic resonance imaging scans performed in patients with asymmetrical sensorineural hearing loss and/or unilateral tinnitus; (2) how many of those patients have actual otological pathology and/or require treatment; and (3) the financial implications of such a reporting practice.MethodRetrospective case series.ResultsBetween October 2015 and November 2016, 500 patients underwent magnetic resonance imaging of the internal auditory meatus to rule out cerebellopontine angle lesions. There was an incidental finding of increased mastoid signalling in 5.8 per cent (n= 29), of which 20.7 per cent (6 of 29) were reported as bilateral cases. The diagnosis of ‘mastoiditis’ was found in 39.7 per cent (29 of 73). None of these patients had any pathology identified clinically. Other significant pathology was identified in a further 8.8 per cent (n= 44).ConclusionThe diagnosis of mastoiditis is primarily clinical. An incidental finding of high signalling in the mastoid region on magnetic resonance imaging is highly unlikely to represent actual clinical disease. In patients who are scanned for other reasons and who do not complain of otological symptoms, such findings are unlikely to require otolaryngology input.

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Comparison of MR imaging findings in paediatric and adult patients with acute mastoiditis and incidental intramastoid bright signal on T2-weighted images

Cited by 7 publications

References 23 publications

Incidental Findings and Normal Anatomical Variants on MRI of the Brain in Adults for Primary Headaches

Incidental Findings and Normal Anatomical Variants on MRI of the Brain in Adults for Primary Headaches

Detection of Coalescent Acute Mastoiditis on MRI in Comparison with CT

Incidental mastoiditis on magnetic resonance imaging scans: clinical relevance and cost implications

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