Hostname: page-component-7c8c6479df-hgkh8 Total loading time: 0 Render date: 2024-03-28T19:17:52.412Z Has data issue: false hasContentIssue false

Incidental mastoiditis on magnetic resonance imaging scans: clinical relevance and cost implications

Published online by Cambridge University Press:  05 November 2018

Y Abbas
Affiliation:
Otolaryngology Department, Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, UK
H S Yuen
Affiliation:
Otolaryngology Department, Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, UK
A Trinidade*
Affiliation:
Otolaryngology Department, Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, UK
G Watters
Affiliation:
Otolaryngology Department, Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, UK
*
Author for correspondence: Mr Aaron Trinidade, Otolaryngology Department, Southend University Hospital NHS Foundation Trust, Prittlewell Chase, Westcliff-on-Sea SS0 0RY, UK E-mail: aaron.trinidade@southend.nhs.uk Fax: +44 (01)702 385 145

Abstract

Objectives

To determine: (1) the incidence of incidental ‘mastoiditis’ reported on magnetic resonance imaging scans performed in patients with asymmetrical sensorineural hearing loss and/or unilateral tinnitus; (2) how many of those patients have actual otological pathology and/or require treatment; and (3) the financial implications of such a reporting practice.

Method

Retrospective case series.

Results

Between October 2015 and November 2016, 500 patients underwent magnetic resonance imaging of the internal auditory meatus to rule out cerebellopontine angle lesions. There was an incidental finding of increased mastoid signalling in 5.8 per cent (n = 29), of which 20.7 per cent (6 of 29) were reported as bilateral cases. The diagnosis of ‘mastoiditis’ was found in 39.7 per cent (29 of 73). None of these patients had any pathology identified clinically. Other significant pathology was identified in a further 8.8 per cent (n = 44).

Conclusion

The diagnosis of mastoiditis is primarily clinical. An incidental finding of high signalling in the mastoid region on magnetic resonance imaging is highly unlikely to represent actual clinical disease. In patients who are scanned for other reasons and who do not complain of otological symptoms, such findings are unlikely to require otolaryngology input.

Type
Main Articles
Copyright
Copyright © JLO (1984) Limited, 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Mr A Trinidade takes responsibility for the integrity of the content of the paper

References

1Anderson, KJ. Mastoiditis. Pediatr Rev 2009;30:233–4Google Scholar
2Mafee, MF, Singleton, EL, Valvassori, GE, Espinosa, GA, Kumar, A, Aimi, K. Acute otomastoiditis and its complications: role of CT. Radiology 1985;155:391–7Google Scholar
3Meredith, JR, Boyev, KP. Mastoiditis on MRI: fact or artifact? Ear Nose Throat J 2008;87:514–19Google Scholar
4Minks, DP, Porte, M, Jenkins, N. Acute mastoiditis: the role of radiology. Clin Radiol 2013;68:397405Google Scholar
5Polat, S, Aksoy, E, Serin, GM, Yıldız, E, Tanyeri, H. Incidental diagnosis of mastoiditis on MRI. Eur Arch Otorhinolaryngol 2011;268:1135–8Google Scholar
6Pauker, SG, Kopelman, RI. Trapped by an incidental finding. NEJM 1992;326:40–3Google Scholar
7Singh, S, Rettiganti, MR, Qin, C, Kuruva, M, Hegde, SV. Incidental mastoid opacification in children on MRI. Pediatr Radiol 2016;46:704–8Google Scholar
8Von Kalle, T, Fabig-Moritz, C, Heumann, H, Winkler, P. Incidental findings in paranasal sinuses and mastoid cells: a cross-sectional magnetic resonance imaging (MRI) study in a pediatric radiology department. Rofo 2012;184:629–34Google Scholar
9Saat, R, Mahmood, G, Laulajainen-Hongisto, A, Lempinen, L, Aarnisalo, AA, Jero, J 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 2016;26:2632–9Google Scholar