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Malignant external otitis: early scintigraphic detection.

A M Strashun, M Nejatheim, S J Goldsmith

    Radiology
    |February 1, 1984
    PubMed
    Summary
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    Technetium-99m and gallium-67 scintigraphy are superior to radiographs and CT scans for detecting malignant external otitis, especially in elderly diabetics. Gallium scintigraphy is also more specific for monitoring treatment effectiveness.

    Area of Science:

    • Nuclear Medicine
    • Radiology
    • Otolaryngology

    Background:

    • Malignant external otitis, a severe Pseudomonas infection, can aggressively spread to adjacent structures in elderly diabetics.
    • Early diagnosis is crucial for effective treatment of this potentially life-threatening condition.

    Purpose of the Study:

    • To compare the diagnostic accuracy of various imaging modalities for detecting temporal bone osteomyelitis in malignant external otitis.
    • To evaluate the sensitivity and specificity of radiographs, CT scans, and radionuclide scintigraphy (Tc-99m MDP and Ga-67 citrate).

    Main Methods:

    • Ten patients with clinical malignant external otitis underwent evaluation using skull radiographs, thin-section temporal bone tomography, CT scans, Tc-99m MDP scintigraphy, Ga-67 citrate scintigraphy, and SPECT.
    • Imaging findings were correlated with the clinical diagnosis of temporal bone osteomyelitis.

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    Main Results:

    • Skull radiographs and thin-section tomography showed low sensitivity for osteomyelitis.
    • CT scans suggested osteomyelitis in only 3 out of 9 patients.
    • Both Tc-99m MDP and Ga-67 citrate scintigraphy were positive in all 10 patients, indicating high sensitivity for detecting osteomyelitis.
    • Ga-67 citrate scintigraphy demonstrated higher specificity, distinguishing active infection from residual inflammation during follow-up.

    Conclusions:

    • Technetium-99m and gallium-67 scintigraphy are more sensitive than conventional imaging for the early detection of malignant external otitis with temporal bone osteomyelitis.
    • Gallium-67 scintigraphy is valuable for assessing treatment response and monitoring disease remission.