Diffusion-Weighted Imaging Does Not Differentiate Between Bacterial and Fungal Skull Base Osteomyelitis.

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Clinical Otolaryngology Pub Date : 2024-11-12 DOI:10.1111/coa.14256

Arun G Karthat, Soumya Regi, Habie Thomas, Katti B Sara, P Beula Subashini, Rajan Sundaresan, Regi Thomas

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引用次数: 0

Abstract

Objective: Apparent diffusion coefficient (ADC) value helps in differentiating infections from neoplasms on magnetic resonance imaging (MRI). We investigate the diffusion-weighted images in skull base osteomyelitis (SBO) to evaluate if ADC values can differentiate fungal and bacterial SBO and to analyse the microbiology of all SBO patients.

Design: Retrospective observational study.

Setting: Quaternary care referral centre.

Participants: A retrospective review of 142 patients diagnosed and treated for SBO patients from January 2010 to May 2023 was done.

Main outcome measure: Chi-square or Fisher's exact test was used to compare ADC values of bacterial and fungal SBO.

Results: The most common pathogens isolated were Pseudomonas (42.2%), Aspergillus (30.98%), and S. aureus (23.94%). The average ADC value of affected soft tissues among patients was 1.13 ± 0.26 × 10^-3 mm2/s compared to the average ADC value of normal soft tissue, 1.34 ± 0.31 × 10^-3 mm2/s. There was no statistical significance when comparing the average ADC values of bacterial and fungal SBO patients (p value = 0.142).

Conclusion: This study suggests that though infection due to Pseudomonas was the commonest, it was detected only in 42.2% of patients. More than half of the cases had organisms other than Pseudomonas, demanding the clinician to obtain deeper biopsies early in the course of the disease for microbiological analysis. DWI does not help differentiate bacterial and fungal SBO, again emphasising the need for deeper tissue biopsies in all these patients to assist in the early identification of the pathogen.

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弥散加权成像无法区分细菌性和真菌性颅底骨髓炎

目的表观弥散系数（ADC）值有助于在磁共振成像（MRI）上区分感染和肿瘤。我们研究了颅底骨髓炎（SBO）的弥散加权图像，以评估 ADC 值能否区分真菌性和细菌性 SBO，并分析所有 SBO 患者的微生物学情况：设计：回顾性观察研究：环境：四级医疗转诊中心：对2010年1月至2023年5月期间诊断和治疗的142名SBO患者进行回顾性研究：采用卡方检验或费雪精确检验比较细菌性和真菌性SBO的ADC值：最常见的病原体是假单胞菌（42.2%）、曲霉菌（30.98%）和金黄色葡萄球菌（23.94%）。患者受影响软组织的平均 ADC 值为 1.13 ± 0.26 × 10-3 mm2/s，而正常软组织的平均 ADC 值为 1.34 ± 0.31 × 10-3 mm2/s。细菌性和真菌性 SBO 患者的平均 ADC 值比较无统计学意义（P 值 = 0.142）：本研究表明，虽然假单胞菌感染最常见，但只有 42.2% 的患者检出了假单胞菌。半数以上的病例感染了假单胞菌以外的其他微生物，这就要求临床医生在病程早期进行更深层次的活检，以进行微生物分析。DWI 无助于区分细菌性和真菌性 SBO，这再次强调了对所有这些患者进行深层组织活检以帮助早期确定病原体的必要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Otolaryngology 医学-耳鼻喉科学

CiteScore

4.00

自引率

4.80%

发文量

106

审稿时长

>12 weeks

期刊介绍： Clinical Otolaryngology is a bimonthly journal devoted to clinically-oriented research papers of the highest scientific standards dealing with: current otorhinolaryngological practice audiology, otology, balance, rhinology, larynx, voice and paediatric ORL head and neck oncology head and neck plastic and reconstructive surgery continuing medical education and ORL training The emphasis is on high quality new work in the clinical field and on fresh, original research. Each issue begins with an editorial expressing the personal opinions of an individual with a particular knowledge of a chosen subject. The main body of each issue is then devoted to original papers carrying important results for those working in the field. In addition, topical review articles are published discussing a particular subject in depth, including not only the opinions of the author but also any controversies surrounding the subject. • Negative/null results In order for research to advance, negative results, which often make a valuable contribution to the field, should be published. However, articles containing negative or null results are frequently not considered for publication or rejected by journals. We welcome papers of this kind, where appropriate and valid power calculations are included that give confidence that a negative result can be relied upon.