Is mastoiditis being over-diagnosed on computed tomography imaging? —radiological versus clinical findings

Pastuszek, Andrew; Lomas, Jonathan; Grigg, Cameron; De, Ranit

doi:10.21037/ajo-20-24

Cited by 6 publications

(7 citation statements)

References 16 publications

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“…The pooled prevalence of IMO on CT 22–25 and MRI 10,11,20,21,26–31 were similar at 8.6% (95% CI 1.8–19.7) and 10.4% (95% CI 4.9–17.6), respectively, as shown in Figure 4. Imaging modality was not found to be a significant moderator (QM (1) = 0.12, P = .73).…”

Section: Resultsmentioning

confidence: 80%

“…There was a large difference in prevalence between studies that measured IMO by screening radiology reports 11,12,21–23,25,31 (3.5%, 95% CI 1.3–6.6) and directly evaluating radiological images 10,20,24,26–30 (14.5%, 95% CI 9.9–19.8), as shown in Figure 7. This difference was highly significant (QM (1) = 16.0, P < .0001) and contributed to the observed heterogeneity ( R 2 = 28.0%).…”

Section: Resultsmentioning

confidence: 99%

“…One would expect radiological features beyond simple opacification, particularly as bony destruction of the mastoid air cells is a feature of coalescent mastoiditis 33 . Pastuszek et al 25 showed mastoid septa erosion was a feature found only in cases that were suspected and confirmed to have acute mastoiditis, and this feature was absent in all cases of IMO, of which none had true mastoiditis. Saat et al 27 compared MRI findings between a group of patients with a clinical diagnosis of acute mastoiditis and a control group.…”

Section: Discussionmentioning

confidence: 99%

“…Sample size. Dividing the studies into sample sizes of less than 11,20,22,24,26,[28][29][30][31] or greater than 1000 10,12,21,23,25,27 demonstrated a small negative regression coefficient (À0.2; Z (13) = À2.9, P = .003), as shown in supplementary file 6. The pooled prevalence in smaller studies was 12.4% (95% CI 8.1-17.3), compared to 4.1% (95% CI 1.5-7.8) in larger studies, as shown in Figure 6.…”

Section: Subgroup and Meta-regression Analysesmentioning

confidence: 93%

“…Nine studies [10][11][12][21][22][23]25,30,32 reported on the clinical features found in patients with IMO as outlined in Table I. Orhan et al 10 identified seven new diagnoses of "acute otomastoiditis due to bacterial infection" in 10 patients that had IMO out of 2270 MRI temporomandibular joint (TMJ) studies.…”

Section: Clinical Outcomes Of Imomentioning

confidence: 99%

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The Prevalence of Incidental Mastoid Opacification and the Need for Intervention: A Meta‐Analysis

2021

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Objectives/Hypothesis: The increasing use of cross-sectional imaging has led to the predicament of incidental mastoid opacification (IMO). We investigated the prevalence of IMO and the clinical need for ENT assessment or intervention when identified.Study Design: Systematic review and meta-analysis. Methods: The PRISMA statement standards were used to search electronic databases including Medline, Embase, PubMed, and Web of Science. The selection criteria were mastoid opacification found on computed tomography (CT) or magnetic resonance imaging (MRI) as incidental findings.Results: A total of 16 studies were identified for qualitative analysis and 15 for quantitative analysis, mainly retrospective. The pooled prevalence of IMO in 246,288 patients was 8.4% (95% CI 5.5-12.0). The prevalence of IMO was significantly higher in studies with children (17.2%, 95% CI 10.9-24.6) than those with adults (6.1%, 95% CI 3.3-9.6); smaller sample size studies (12.4%, 95% CI 8.1-17.3) compared to larger sample size studies (4.1%, 95% CI 1.5-7.8); and when IMO was detected by viewing images (14.5%, 95% CI 9.9-19.8) compared to reading reports (3.5%, 95% CI 1.3-6.6). Imaging modality was not a significant moderator due to similar IMO rate on CT (8.6%, 95% CI 1.8-19.7) and MRI (10.4%, 95% CI 4.9-17.6). Nine studies reported on clinical outcomes of patients with IMO, and none reliably reported any cases of clinical mastoiditis.Conclusions: The term "mastoiditis" on radiology reports based on IMO does not indicate a clinical diagnosis of mastoiditis, although the current body of evidence is limited. Otolaryngology review is suggested if clinical correlation detects otological signs or symptoms.

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Section: Resultsmentioning

confidence: 80%

Section: Resultsmentioning

confidence: 99%