Jansen Robin W, Kemp Pieter, Wiegers Sanne E, de Graaf Pim, van Schie Annelies, Martens Roland M, Boellaard Ronald, Zwezerijnen Gerben J C, Goderie Thadé
Department of Otolaryngology-Head and Neck Surgery.
Department of Radiology and Nuclear Medicine, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
Otol Neurotol. 2025 Mar 1;46(3):295-302. doi: 10.1097/MAO.0000000000004402. Epub 2025 Jan 9.
This study aims to identify 18 F-FDG-PET imaging features for improving treatment response evaluation in patients with necrotizing otitis externa (NOE), aiding in the difficult differentiation between sterile inflammation and active infection.
Retrospective cohort study.
Tertiary hospital.
Patients diagnosed with NOE between 2011 and 2022. NOE criteria included otalgia, otorrhea, granulation, and radiological features consistent with osteomyelitis.
18 F-FDG-PET/computed tomography (CT) parameters were derived from manually delineated regions of interest and were evaluated on both pretreatment and end-of-treatment scans.
Recurrent disease of NOE after end-of-treatment 18 F-FDG-PET scans.
This study comprised 20 NOE patients, including 5 (25%) experiencing recurrent disease after the end-of-treatment scan. The end-of-treatment 18 F-FDG-PET parameters of maximal and peak standardized uptake value (SUVmax and SUVpeak) were significantly higher in recurrent cases ( p = 0.025 and p = 0.025, respectively). Both parameters demonstrated good discrimination ability in predicting recurrence, with optimal cutoffs yielding 100% sensitivity and 67% specificity. Other parameters, including mean SUV and total lesion glycolysis (TLG), did not yield significant results, neither did the calculated difference in uptake between end-of-treatment and pretreatment scans.
SUVpeak on 18 F-FDG-PET was the preferred parameter for treatment response evaluation of NOE at the end-of-treatment scan. A high residual SUVpeak may adequately detect patients at risk for recurrent disease, which may necessitate prolonged treatment, while low SUVpeak is found in patients with low risk for recurrent disease permitting safe treatment cessation.
本研究旨在确定18F-FDG-PET成像特征，以改善坏死性外耳道炎（NOE）患者的治疗反应评估，辅助鉴别无菌性炎症和活动性感染。
回顾性队列研究。
三级医院。
2011年至2022年间诊断为NOE的患者。NOE标准包括耳痛、耳漏、肉芽组织以及与骨髓炎相符的影像学特征。
18F-FDG-PET/计算机断层扫描（CT）参数来自手动勾勒的感兴趣区域，并在治疗前和治疗结束时的扫描中进行评估。
治疗结束后18F-FDG-PET扫描时NOE的复发疾病情况。
本研究纳入20例NOE患者，其中5例（25%）在治疗结束后扫描时出现疾病复发。复发病例治疗结束时18F-FDG-PET的最大和峰值标准化摄取值（SUVmax和SUVpeak）参数显著更高（分别为p = 0.025和p = 0.025）。这两个参数在预测复发方面均显示出良好的辨别能力，最佳截断值的灵敏度为100%，特异性为67%。其他参数，包括平均SUV和总病变糖酵解（TLG），未得出显著结果，治疗结束和治疗前扫描之间计算的摄取差异也未得出显著结果。
18F-FDG-PET上的SUVpeak是治疗结束时扫描评估NOE治疗反应的首选参数。高残留SUVpeak可能足以检测出有疾病复发风险的患者，这些患者可能需要延长治疗时间，而复发风险低的患者SUVpeak较低，允许安全停止治疗。
