Imaging

Mastoiditis

Preliminary Diagnosis: Mastoiditis

I. What imaging technique is first-line for this diagnosis

  • CT of the brain without contrast.

  • CT Temporal Bone without contrast may additionally be performed for more coned down views of the mastoid air cells and associated temporal bone structures.

II. Describe the advantages and disadvantages of this technique for diagnosis of mastoiditis.

Advantages

  • Fast, inexpensive imaging modality

Disadvantages

  • Exposes patients to ionizing radiation

  • Great for evaluating any bony abnormalities such as erosive changes or any secondary changes from coalescent mastoiditis

III. What are the contraindications for the first-line imaging technique?

  • CT imaging may be contraindicated in pregnant patients.

IV. What alternative imaging techniques are available?

  • MR of the brain with and without contrast

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of mastoiditis.

MR of the brain with and without contrast

Advantages

  • More sensitive and specific in identifying and diagnosing any secondary abscess or subjacent cellulitis than CT

Disadvantages

  • Expensive

  • Time-consuming

  • Requires significant patient cooperation to minimize motion artifact

VI. What are the contraindications for the alternative imaging techniques?

MR of the brain with and without contrast

  • Contraindicated in patients with non-MR compatible hardware

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