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Article Abstract
Objective: The duration of antibiotic treatment for necrotizing otitis externa (NEO) and the criteria for discontinuation are currently uncodified. Our study evaluated the performance of [18F]FDG PET to assess the therapeutic response of NEO.
Methods: We retrospectively included patients treated for NEO who underwent a PET scan at baseline and 4 to 9 weeks after antibiotic initiation. PET images were analyzed visually and quantitatively (SUVmax, Total Lesion Glycolysis [TLG], and Total Metabolic Volume [TMV]). An intensity-weighted extent score (extent) that we created was also calculated. For each parameter, delta values ("∆": percentage change from baseline for each parameter) were also calculated.
Results: Thirty-nine patients and 40 ears were enrolled. Pseudomonas aeruginosa was isolated from 32 (86%) samples. Twenty-nine (72.5%) patients were treated with CEFTAZIDIME and CIPROFLOXACIN for a median of 6.9 weeks. On PET scan re-evaluation, 15 (27.5%) patients were visually in complete response, 17 (42.5%) in partial response, 5 (12.5%) stable, and 3 (7.5%) in progression. The sensitivity and specificity of visual analysis for the diagnosis of recovery were 100% and 43%, respectively. The best performing parameters for predicting recurrence were initial TLG and TMV (sensitivity and specificity of 80% and 100% for respective thresholds of 50.1 g and 8.3 mL). ∆extent showed sensitivity and specificity of 80% and 97.1% using a threshold of -4.3%, and ∆TLG showed sensitivity and specificity of 80% and 94.3% using a threshold of -37.4%.
Conclusion: PET performed well in assessing the therapeutic response of NEO, with excellent sensitivity but low specificity of visual analysis. A complementary quantitative analysis was useful to distinguish between satisfactory and insufficient partial responses.
Level Of Evidence: Level 3.
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