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Comparison of MR imaging findings in paediatric and adult patients with acute mastoiditis and incidental intramastoid bright signal on T2-weighted images

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Abstract

Objectives

To compare MR imaging features in patients with incidental mastoid T2-hyperintensity with those of clinical acute mastoiditis, to ascertain characteristic differences between them.

Methods

MR images of 35 adult and paediatric patients with clinical acute mastoiditis and 34 consecutive age-matched controls without relevant middle ear pathology and with incidental T2-hyperintensity that covered ≥ 50 % of the mastoid were retrospectively analysed with regard to signal, diffusion, and enhancement characteristics, and presence of complications.

Results

Incidental mastoid T2-hyperintensity that covered ≥ 50 % of the mastoid volume was found in 4.6 % of reviewed MR scans (n = 2341), and associated significantly (p < 0.05) less with the involvement of the tympanic cavity (38 % vs. 74 %) and mastoid antrum (56 % vs. 80 %), hypointense-to-CSF signal intensity on T2 FSE (6 % vs. 86 %), intramastoid diffusion restriction (0 % vs. 62 %), intense intramastoid enhancement (0 % vs. 51 %), periosteal enhancement (3 % vs. 69 %), perimastoid dural enhancement 3 % vs. 43 %), bone destruction (0 % vs 49 %), intratemporal abscess or cholesteatoma (0 % vs. 24 %), labyrinth involvement (0 % vs. 14 %), and extracranial abscesses (0 % vs. 20 %).

Conclusion

Hypointense-to-CSF signal intensity on T2WI, restricted diffusion, intense intramastoid enhancement among other MR imaging characteristics favoured an acute mastoiditis diagnosis over clinically non-relevant incidental mastoid pathology.

Key Points

• Intramastoid T2-hyperintensity alone is not a reliable sign for acute mastoiditis.

• In acute mastoiditis, intramastoid T2-weighted signal intensity is usually hypointense to CSF.

• Diffusion restriction and intense intramastoid enhancement are absent in incidental mastoid effusion.

• An ADC value ≥ 1.72 × 10 -3 mm 2 /s contradicts the AM diagnosis.

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Abbreviations

AM:

acute mastoiditis

SI:

signal intensity

ROC:

receiver operating characteristic

AUC:

area under the curve

SNHL:

sensorineural hearing loss

CSF:

cerebrospinal fluid

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Acknowledgements

The scientific guarantor of this publication is Antti Markkola M.D., Ph.D. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. This study has received funding by Helsinki University Hospital Research Funds. Timo Pessi MSc kindly provided statistical advice for this manuscript. Institutional Review Board approval was obtained. Written informed consent was not required for this type of retrospective study. Some study subjects or cohorts have been previously reported in Am J Neuroradiol. 2015 Feb;36(2):361-7. Methodology: retrospective, diagnostic study, performed at one institution.

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Authors and Affiliations

  1. Department of Radiology, HUS Medical Imaging Centre, Helsinki University Hospital and University of Helsinki, POB 340, Haartmaninkatu 4, Helsinki, 00029, Finland

    R. Saat, G. Mahmood & A. Markkola

  2. Department of Radiology, East Tallinn Central Hospital, Tallinn, Estonia

    R. Saat

  3. Department of Otorhinolaryngology and Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland

    A. Laulajainen-Hongisto, L. Lempinen, A. A. Aarnisalo & J. Jero

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  1. R. Saat
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  2. G. Mahmood
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  3. A. Laulajainen-Hongisto
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  4. L. Lempinen
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  5. A. A. Aarnisalo
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  6. J. Jero
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  7. A. Markkola
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Correspondence to R. Saat.

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Saat, R., Mahmood, G., Laulajainen-Hongisto, A. et al. Comparison of MR imaging findings in paediatric and adult patients with acute mastoiditis and incidental intramastoid bright signal on T2-weighted images. Eur Radiol 26, 2632–2639 (2016). https://doi.org/10.1007/s00330-015-4113-5

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  • DOI: https://doi.org/10.1007/s00330-015-4113-5

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