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Central Skull Base Osteomyelitis: Multimodality Imaging and Clinical Findings from a Large Indian Cohort
Boby V Maramattom1, S Ananth Ram1, Vineeth Viswam2
1Department of Neurology, Aster Medcity, Kothad, Kochi, Kerala, India.
Central or atypical skull base osteomyelitis (CSBO) is a severe condition often missed by MRI. Combined PET-CT and bone scans are crucial for diagnosing CSBO and monitoring treatment response.
Area of Science:
- Neuroimaging
- Infectious Diseases
- Skull Base Disorders
Background:
- Central or atypical skull base osteomyelitis (CSBO) presents with severe headache and cranial nerve deficits.
- Conventional MRI and CT scans show limited specificity and sensitivity for CSBO diagnosis.
Purpose of the Study:
- To analyze a cohort of patients diagnosed with CSBO.
- To evaluate the diagnostic utility of advanced imaging techniques in CSBO.
Main Methods:
- Retrospective analysis of 17 CSBO patients (2015-2020).
- Utilized 3T MRI Brain, MR angiography, FDG PET-CT, and 99mTc MDP/SPECT-CT.
- Bacterial and fungal cultures from surgical biopsies were performed.
Main Results:
- 88% of patients experienced severe unilateral headache; all had cranial mono/polyneuritis.
- MRI was normal in 42% of patients.
- FDG PET-CT and 99mTc MDP scans with SPECT-CT were abnormal in all patients, indicating disease presence.
Conclusions:
- CSBO has a high mortality rate (40%) and significant morbidity.
- Repeated PET-CT and bone scans are necessary for monitoring disease regression.
- The combination of MRI, FDG PET-CT, and 99mTc bone scan with SPECT-CT effectively detects CSBO and its progression.
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