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Can computed tomography and magnetic resonance imaging differentiate between malignant pathology and osteomyelitis in the central skull base?

Published online by Cambridge University Press:  28 August 2015

F D Lesser ,
S G Derbyshire  and
H Lewis-Jones
F D Lesser*
Affiliation:
Emergency Department, Queen's Hospital, Romford, UK
S G Derbyshire
Affiliation:
Department of ENT, Aintree University Hospital, Liverpool, UK
H Lewis-Jones
Affiliation:
Department of Radiology, Aintree University Hospital, Liverpool, UK
*
Address for correspondence: Mr Finnian D Lesser, Emergency Department, Queen's Hospital, Rom Valley Way, Romford RM7 0AG, UK E-mail: [email protected]
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Abstract

Background:

Central skull base osteomyelitis is clinically difficult to distinguish from malignancy.

Method:

The computed tomography and magnetic resonance imaging scans of six patients with central skull base osteomyelitis were compared with scans from patients with a range of skull base conditions.

Results and conclusion:

Computed tomography scans of central skull base osteomyelitis show much less bony destruction relative to the magnetic resonance imaging changes, whereas malignancy cases were associated with similar bony destruction on computed tomography and magnetic resonance imaging. In magnetic resonance imaging scans, it was possible to confirm previous findings of clival hypointensity on T1-weighted images relative to normal fatty marrow. In addition, there were signs of pre- and para-clival soft tissue infiltration, with the obliteration of normal fat planes and frank soft tissue masses in all six central skull base osteomyelitis patients. Signal intensity on T2-weighted images of the clivus was high in five central skull base osteomyelitis patients. With intravenous contrast, fascial plane anatomy appeared restored in central skull base osteomyelitis cases, almost in keeping with that of non-involved areas. This was not a feature in any of the malignant conditions.

Keywords

OsteomyelitisSkull BaseRadiology
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 129 , Issue 9 , September 2015 , pp. 852 - 859
Copyright
Copyright © JLO (1984) Limited 2015 

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References

1Meltzer, PE, Kelemen, G. Pyocyaneus osteomyelitis of the temporal bone, mandible and zygoma. Laryngoscope 1959;69:1300–16CrossRefGoogle Scholar
2Patmore, H, Jebreel, A, Uppal, S, Raine, CH, McWhinney, P. Skull base infection presenting with multiple lower cranial nerve palsies. Am J Otolaryngol 2010;31:376–80CrossRefGoogle ScholarPubMed
3Clark, MP, Pretorius, PM, Byren, I, Milford, CA. Central or atypical skull base osteomyelitis: diagnosis and treatment. Skull Base 2009;19:247–54CrossRefGoogle ScholarPubMed
4Cavel, O, Fliss, DM, Segev, Y, Zik, D, Khafif, A, Landsberg, R. The role of the otorhinolaryngologist in the management of central skull base osteomyelitis. Am J Rhinol 2007;21:281–5CrossRefGoogle ScholarPubMed
5Sharma, A, Deshmukh, S, Shaikh, A, Dabholkar, J. Wegener's granulomatosis mimicking skull base osteomyelitis. J Laryngol Otol 2012;126:203–6CrossRefGoogle ScholarPubMed
6Ozgen, B, Oguz, K, Cila, A. Diffusion MR imaging features of skull base osteomyelitis compared with skull base malignancy. AJNR Am J Neuroradiol 2011;32:179–84CrossRefGoogle ScholarPubMed
7Chandler, JR, Grobman, L, Quencer, R, Serafini, A. Osteomyelitis of the base of the skull. Laryngoscope 1986;96:245–51CrossRefGoogle ScholarPubMed
8Johnson, AK, Batra, PS. Central skull base osteomyelitis. Laryngoscope 2014;124:1083–7CrossRefGoogle ScholarPubMed
9Adams, A, Offiah, C. Central skull base osteomyelitis as a complication of necrotizing otitis externa: imaging findings, complications, and challenges of diagnosis. Clin Radiol 2012;67:e7–16CrossRefGoogle ScholarPubMed
10Chang, PC, Fischbein, NJ, Holliday, RA. Central skull base osteomyelitis in patients without otitis externa: imaging findings. AJNR Am J Neuroradiol 2003;24:1310–16Google ScholarPubMed
11Grandis, JR, Curtin, HD, Yu, VL. Necrotizing (malignant) external otitis: prospective comparison of CT and MR imaging in diagnosis and follow-up. Radiology 1995;196:499–504CrossRefGoogle Scholar
12Singh, A, Al Khabori, M, Hyder, MJ. Skull base osteomyelitis: diagnostic and therapeutic challenges in atypical presentation. Otolaryngol Head Neck Surg 2005;133:121–5CrossRefGoogle ScholarPubMed