Diagnosis of Skull Base Osteomyelitis

Jáñez, Fátima Álvarez; Barriga, Luis Q.; Iñigo, Tania Rocha; Lora, Florinda Roldán

doi:10.1148/rg.2021200046

Cited by 41 publications

(64 citation statements)

References 44 publications

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“…19 This is sometimes referred to as extrasinonasal LoCE lesion 7 and not encountered in bacterial SBO. 20 Abscess formation seen in bacterial SBO is not a feature of fungal SBO. Thus, necrosis or tissue infarction are features of fungal SBO contrasting with suppuration, which is the hallmark of bacterial/pyogenic SBO.…”

Section: Radiological Featuresmentioning

confidence: 98%

Imaging of COVID-19-associated craniofacial mucormycosis: a black and white review of the “black fungus”

Sanghvi

Kale

2021

Clinical Radiology

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A subset of diabetic COVID-19 patients treated with steroids, oxygen, and/or prolonged intensive care admission develop rhino-orbito-cerebral mucormycosis. Radiologists must have a high index of suspicion for early diagnosis, which prompts immediate institution of antifungal therapy that limits morbidity and mortality. Assessment of disease extent by imaging is crucial for planning surgical debridement. Complete debridement of necrotic tissue improves survival. Imaging features reflect the angioinvasive behaviour of fungal hyphae from the Mucoraceae family, which cause necrotising vasculitis and thrombosis resulting in extensive tissue infarction. Contrast-enhanced magnetic resonance imaging (MRI) is the imaging technique of choice. The classic “black turbinate” on contrast-enhanced imaging represents localised invasive fungal rhinosinusitis (IFRS). A striking radiological feature of disseminated craniofacial disease is non-enhancing devitalised and necrotic soft tissue at the orbits and central skull base. Sinonasal and extrasinonasal non-enhancing lesions in IFRS are secondary to coagulative necrosis induced by fungal elements. Multicompartmental and extrasinonasal tissue infarction is possible without overt bone involvement and caused by the propensity of fungal elements to disseminate from the nasal cavity via perineural and perivascular routes. Fungal vasculitis can result in internal carotid artery occlusion and cerebral infarction. Remnant non-enhancing lesions after surgical debridement portend a poor prognosis. Assessment for the non-enhancing MRI lesion is crucial, as it is a sole independent prognostic factor for IFRS-specific mortality. In this review, we describe common and uncommon imaging presentations of biopsy-proven rhino-orbito-cerebral mucormycosis in a cohort of nearly 40 COVID-19 patients.

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Section: Radiological Featuresmentioning

confidence: 98%

Imaging of COVID-19-associated craniofacial mucormycosis: a black and white review of the “black fungus”

Sanghvi

Kale

2021

Clinical Radiology

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“…Unfortunately, radiological findings may lead to an erroneous diagnosis as well because the radiologic features of GPA often overlap with those of other diseases [9][10][11][12][13][14][15][16][17][18]29], delaying the time to diagnosis [3,23,[29][30][31]. Accordingly, it is not surprising that there have been several case reports published on GPA cases in which the MRI findings mimicked those of SBO or NPC [9][10][11][12][13][14][15][16][17][18]29], or that, to date, no studies have identified MRI findings possessing diagnostic value for differentiating between these diseases. Nevertheless, the advent of high-resolution MRI has facilitated a more detailed assessment of the imaging characteristics and the extent of such lesions, and the diagnostic role of MRI is expanding.…”

Section: Discussionmentioning

confidence: 99%

“…Second, the margin of the lesion was mostly partially defined in cases of NPC, whereas it was mostly poorly defined in cases of GPA and SBO. Since GPA and SBO are characterized by inflammatory pathologies, they must be considered infiltrative in nature [8,[14][15][16][17][18]29]. In contrast, NPC lesions are typically more defined; however, since we enrolled patients with NPC of clinical tumor stage 3 or higher, most of the NPC lesions were only partially defined, probably due to the skull base infiltration.…”

Section: Discussionmentioning

confidence: 99%

Radiologic Differentiation between Granulomatosis with Polyangiitis and Its Mimics Involving the Skull Base in Humans Using High-Resolution Magnetic Resonance Imaging

et al. 2021

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Granulomatosis with polyangiitis (GPA) can involve the skull base or the Eustachian tubes. GPA is diagnosed on the basis of clinical manifestations and serological tests, although it is challenging to discriminate GPA from infectious processes driving skull base osteomyelitis (SBO) and malignant processes such as nasopharyngeal carcinoma (NPC). Moreover, current serological tests have a low sensitivity and cannot distinguish GPA from these other conditions. We hypothesized that certain MRI characteristics would differ significantly among conditions and aimed to evaluate whether the features could differentiate between GPA, SBO, and NPC involving the skull base. We retrospectively evaluated the MRI findings of patients with GPA, SBO, and NPC. We performed univariable logistic regression analyses to identify the predictive variables for differentiating between conditions and evaluated their diagnostic values. We showed, for the first time, that certain MRI findings significantly differed between patients with GPA and those with SBO or NPC, including the lesion morphology and extent, the apparent diffusion coefficient (ADC) values, the contrast enhancement patterns, the presence or absence of necrosis, and retropharyngeal lymphadenopathy. In conclusion, utilizing certain MRI features can improve the diagnostic performance of MRI by differentiating GPA with skull base involvement from other conditions with similar radiologic findings, including SBO and NPC, facilitating treatment plans and, thus, improving patient outcomes.

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“… 6 Anterior, central, and posterior SBOs were categorized according to skull base anatomy—anterior clinoid process and lesser wing of sphenoid constitute anterior, greater wing of sphenoid and petrous part of temporal bone denote central, and clivus involvement is indicative of posterior SBO. 7 CN palsy was classified as single or multiple and in case of multiple, the patients were further categorized as predominantly upper CN palsy (I–VI) or lower CN palsy (VII–XII) or both. All patients with postoperative involvement of temporal bone flap and posttraumatic or iatrogenic osteomyelitis of skull base were excluded.…”

Section: Methodsmentioning

confidence: 99%

Predicting Outcome in Skull Base Osteomyelitis: An Assessment of Demographic, Clinical, and Pathological Attributes

Saxena

Paul

Singh

et al. 2021

JNRP

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Objective Skull base osteomyelitis (SBO) is an enigmatic clinical diagnosis which is difficult to decipher and is associated with poor outcomes. The study aims to examine the demographic and clinical characteristics of patients with SBO and its outcomes. Materials and Methods Medical records of 30 patients with diagnosis of SBO over past 5 years were assessed for demographic and clinical characteristics, type of SBO, radiological parameters, treatment received, procedure performed, microbiological profile, comorbidities, and complications including cranial nerve (CN) palsies. These factors were analyzed for prediction of outcome (death or survival). Statistical Analysis Microsoft Office Excel 2010 SAS 10.0 for Windows was used. Student's t-test for continuous variables (age, duration of symptoms, number of days of hospitalization, and treatment duration) and chi-square test for categorical variables (imaging findings, symptomatology, presence of comorbidities, surgical procedure, complications, and type of antibiotics) were utilized. Results We found SBO was the disease of elderly population (64.07 ± 6.13 years) with male predominance (83.3%) highly associated with uncontrolled diabetes status (93.3%). Headache (100%) and CN palsy (80%) were the most common neurological presenting complaints followed by stroke (17%) and encephalopathy (10%). Pathological and radiological correlation showed that fungal infection (Aspergillus) was associated with anterior SBO (10%), while bacteria (Pseudomonas) was cultured from posterior SBO (30%). Fifty per cent of patients were alive after 1 year out of which 33% had good functional outcome. The mortality rate was 33.3% in our cohort and multiple lower CN palsies (p = 0.04), suboptimal duration of medical treatment (p = 0.03), surgical intervention during clinical course (p = 0.02), and development of intracranial or extracranial complications (p = 0.03) were the predictors of mortality. Conclusion Early diagnosis including identification of pathogenic organisms and optimal duration of treatment are crucial factors for improved outcomes in SBO.

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Diagnosis of Skull Base Osteomyelitis

Cited by 41 publications

References 44 publications

Imaging of COVID-19-associated craniofacial mucormycosis: a black and white review of the “black fungus”

Imaging of COVID-19-associated craniofacial mucormycosis: a black and white review of the “black fungus”

Radiologic Differentiation between Granulomatosis with Polyangiitis and Its Mimics Involving the Skull Base in Humans Using High-Resolution Magnetic Resonance Imaging

Predicting Outcome in Skull Base Osteomyelitis: An Assessment of Demographic, Clinical, and Pathological Attributes

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