Is CT with or without contrast recommended for diagnosing mastoiditis?

From the Research

CT with contrast is recommended for diagnosing mastoiditis, as it provides superior visualization of soft tissue involvement, abscess formation, and potential intracranial complications, allowing for better assessment of disease extent and complications. While non-contrast CT can show bony erosion and opacification of mastoid air cells, contrast-enhanced CT is essential for identifying asymptomatic complications, as noted in a study published in 2009 1. The contrast agent helps differentiate between inflammatory changes and fluid collections, enabling better evaluation of disease extent and complications such as venous sinus thrombosis, meningitis, or brain abscess.

In clinical practice, many radiologists prefer to perform CT with contrast when mastoiditis is suspected, particularly when evaluating for complications or in cases where the diagnosis is uncertain. However, in situations where contrast is contraindicated (such as in patients with severe renal impairment or contrast allergy), non-contrast CT can still provide valuable diagnostic information about the bony structures and air cells, though it may be less sensitive for detecting complications. A more recent study from 2018 2 supports the use of contrast-enhanced CT for diagnosing intracranial complications of acute mastoiditis, highlighting the importance of accurate imaging for guiding treatment decisions.

Some key points to consider when diagnosing mastoiditis include:

• The use of CT with contrast to evaluate for intracranial complications and soft tissue involvement
• The importance of early imaging to detect potential complications and guide treatment
• The role of clinical symptoms and laboratory results in informing the need for imaging studies
• The potential for CT and MRI to provide complementary information in the diagnosis and management of mastoiditis, as noted in studies from 2016 3 and 2015 4.

Overall, the use of CT with contrast is a crucial component of diagnosing and managing mastoiditis, particularly in cases where complications are suspected or the diagnosis is uncertain.