title: Semiquantitative skull planar and SPECT bone scintigraphy in diabetic patients: differentiation of necrotizing (malignant) external otitis from severe external otitis.
abstract: Early diagnosis of necrotizing external otitis (NEO) includes the use of bone scintigraphy since clinical assessment alone cannot differentiate the necrotizing type of otitis from the severe type of external otitis in which there is no extension to the adjacent bone. Four-hour planar bone scintigraphy may reflect soft-tissue infection, and therefore may not be useful in distinguishing NEO from severe external otitis (SEO). Twenty-four-hour bone scintigraphy using planar or SPECT imaging may better reflect bone uptake and increase the accuracy of the test.
  
  
  METHODS
  Twenty-six diabetic patients (12 diagnosed NEO; 14 SEO) and 10 nondiabetic (ND) patients were studied. Lesion-to-nonlesion (L/N) count ratios obtained from planar and SPECT imaging at 4 hr, 24 hr and 24 hr/4 hr (24/4) were assessed.
  
  
  RESULTS
  Count ratios obtained from the 4- and 24-hr planar and SPECT images were significantly higher in the NEO patients compared to SEO patients for both planar and SPECT studies (p < 0.001, 0.005). The 24/4 count ratio was also significantly higher in the NEO patients on the planar (p < 0.01) and the SPECT studies (p < 0.001). The ND patients were not different from SEO patients on 4-hr planar, 4- and 24-hr SPECT as well as 24/4-hr planar and SPECT studies. The L/N count ratio threshold yielding the best sensitivity for detecting NEO was 1.05 for the 24/4 SPECT study.
  
  
  CONCLUSIONS
  In diabetic patients, an early distinction between NEO and SEO patients can be reliably made by using L/N count ratios on 24/4 or 24-hr SPECT bone scintigraphy.
authors.affiliation: Department of Nuclear Medicine, Carmel Medical Center, Haifa, Israel.
authors.forename: R
authors.initials: R
authors.lastname: Hardoff
authors.forename: S
authors.initials: S
authors.lastname: Gips
authors.forename: N
authors.initials: N
authors.lastname: Uri
authors.forename: A
authors.initials: A
authors.lastname: Front
authors.forename: A
authors.initials: A
authors.lastname: Tamir
mesh_terms: D048909:Diabetes Complications; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000000981:diagnostic imaging* / Q000453:epidemiology; D010032:Otitis Externa / Q000000981:diagnostic imaging* / Q000453:epidemiology; D011446:Prospective Studies; D011552:Pseudomonas Infections / Q000000981:diagnostic imaging* / Q000453:epidemiology; D012680:Sensitivity and Specificity; D013669:Technetium Tc 99m Medronate; D013701:Temporal Bone / Q000000981:diagnostic imaging*; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D013669:Technetium Tc 99m Medronate