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MRI Findings in Acute Tonsillar Infections
J Heikkinen1, J Nurminen1, J Velhonoja2
1From the Departments of Radiology (J. Heikkinen, J.N., T.H., M.N., K.M., J. Hirvonen).
Background And Purpose:
Previous literature is vague on the prevalence and exact nature of abscesses in tonsillar infections, ranging from intratonsillar and peritonsillar collections to deep extension involving the parapharyngeal and retropharyngeal spaces. MR imaging has excellent diagnostic accuracy in detecting neck infections and can potentially clarify this issue. We sought to characterize the spectrum of MR imaging findings regarding tonsillar infections.
Materials And Methods:
We conducted a retrospective cohort study of emergency neck MR imaging scans of patients with tonsillar infections. Imaging data were assessed in terms of signs of infection and the location of abscesses and were compared with clinical findings, final diagnoses, and surgical findings as reference standards.
Results:
The study included 132 patients with tonsillar infection. Of these, 110 patients (83%) had ≥1 abscess (99 unilateral, 11 bilateral; average volume, 3.2 mL). Most abscesses were peritonsillar, and we found no evidence of intratonsillar abscess. Imaging showed evidence of parapharyngeal and retropharyngeal extension in 36% and 10% of patients, respectively. MR imaging had a high positive predictive value for both abscesses (0.98) and deep extension (0.86). Patients with large abscesses and widespread edema patterns had a more severe course of illness.
Conclusions:
Emergency neck MR imaging can accurately describe the extent and nature of abscess formation in tonsillar infections.
Insights
Magnetic resonance (MR) imaging accurately identifies abscesses in tonsillar infections, revealing most are peritonsillar. This imaging technique clarifies the extent of infection, including deep neck space involvement, aiding in patient management.
Area of Science:
- Radiology
- Infectious Diseases
- Otolaryngology
Background:
- Tonsillar infections can involve abscesses ranging from intratonsillar to deep neck spaces.
- Previous literature lacks clarity on the prevalence and precise nature of these abscesses.
- Magnetic resonance (MR) imaging offers high diagnostic accuracy for neck infections.
Purpose of the Study:
- To characterize the spectrum of MR imaging findings in tonsillar infections.
- To determine the prevalence and location of abscesses associated with tonsillar infections.
- To assess the utility of MR imaging in identifying deep neck space extension.
Main Methods:
- Retrospective cohort study of emergency neck MR imaging scans in patients with tonsillar infections.
- Assessment of imaging findings for signs of infection and abscess location.
- Comparison of imaging findings with clinical, surgical, and final diagnoses.
Main Results:
- 132 patients with tonsillar infection were included; 83% had at least one abscess.
- Most abscesses were peritonsillar; no intratonsillar abscesses were identified.
- MR imaging demonstrated parapharyngeal (36%) and retropharyngeal (10%) extension; positive predictive values were 0.98 for abscesses and 0.86 for deep extension.
Conclusions:
- Emergency neck MR imaging accurately delineates the extent and nature of abscess formation in tonsillar infections.
- MR imaging is a valuable tool for characterizing complications of tonsillar infections.
- Findings aid in understanding the spectrum of tonsillar abscesses and their potential for deep extension.
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