Stern Shavit Sagit, Bernstine Hanna, Sopov Vladimir, Nageris Ben, Hilly Ohad
Department of Otolaryngology-Head and Neck Surgery, Petach Tikva, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Laryngoscope. 2019 Apr;129(4):961-966. doi: 10.1002/lary.27526. Epub 2018 Dec 14.
Imaging is important for the diagnosis and follow-up of necrotizing external otitis (NEO). The best imaging modality is controversy. To suggest 2-deoxy-2-[fluorine-18] fluoro-D-glucose-positron emission tomography/computed tomography (18F-FDG-PET/CT) as an alternative to technetium-99m and gallium-67 scans for diagnosis and assessment of response to treatment for patients with NEO.
Case series.
Tertiary referral center. From 2013 through 2017, 12 patients were diagnosed with NEO based on clinical features and positive FDG uptake within the temporal bone on PET/CT. Mean age was 74 ± 11.5; 83% of the patients were male; and 83% had diabetes.
PET/CT scans were reviewed independently by two nuclear medicine specialists. Imaging located osteomyelitis in external ear canal, mastoid, temporomandibular joint, and nasopharyngeal region (100%, 50%, 16%, 8%, respectively). Mean follow-up was 16 months. Eight patients (67%) underwent a second PET/CT scan after active otitis resolved and after at least 6 weeks of antibiotic treatment. The scan demonstrated no or substantially reduced FDG uptake and treatment was stopped. The patients had no NEO symptoms at the end of follow-up. One patient had significant uptake, and antibiotic treatment was continued until a third scan demonstrated no FDG uptake. Two patients died before the second PET/CT, and two were lost to follow-up.
18F-FDG-PET/CT is a reliable imaging modality for diagnosis, disease localization, and decision making regarding treatment cessation. 18F-FDG-PET/CT should be considered as the imaging modality of choice for initial diagnosis and follow-up in NEO patients. Larger, controlled studies are warranted.
4 Laryngoscope, 129:961-966, 2019.
影像学检查对于坏死性外耳道炎（NEO）的诊断及随访具有重要意义。最佳的影像学检查方式存在争议。本研究旨在推荐使用2-脱氧-2-[氟-18]氟代-D-葡萄糖-正电子发射断层扫描/计算机断层扫描（18F-FDG-PET/CT），以替代锝-99m和镓-67扫描，用于NEO患者的诊断及治疗反应评估。
病例系列研究。
三级转诊中心。2013年至2017年期间，12例患者根据临床特征及PET/CT显示颞骨内FDG摄取阳性被诊断为NEO。平均年龄为74±11.5岁；83%的患者为男性；83%的患者患有糖尿病。
两名核医学专家独立回顾PET/CT扫描结果。影像学检查发现外耳道、乳突、颞下颌关节及鼻咽部骨髓炎的发生率分别为100%、50%、16%、8%。平均随访时间为16个月。8例患者（67%）在活动性中耳炎消退且接受至少6周抗生素治疗后接受了第二次PET/CT扫描。扫描显示FDG摄取无或显著降低，治疗停止。随访结束时，这些患者无NEO症状。1例患者FDG摄取显著，抗生素治疗持续至第三次扫描显示无FDG摄取。2例患者在第二次PET/CT检查前死亡，2例失访。
18F-FDG-PET/CT是一种用于诊断、疾病定位及决定是否停止治疗的可靠影像学检查方式。18F-FDG-PET/CT应被视为NEO患者初始诊断及随访的首选影像学检查方式。有必要开展更大规模的对照研究。
4 喉镜，129:961-966，2019年。
