Imaging of Acute and Chronic Skull Base Infection

Neuroimaging Clin N Am. 2021 Nov;31(4):571-598. doi: 10.1016/j.nic.2021.06.002.


Skull base infections are uncommon but can be life threatening without timely recognition. Imaging plays a crucial role because symptoms can be vague and nonlocalizing. Necrotizing otitis externa in diabetic or immunocompromised patients is the commonest cause of skull base osteomyelitis (SBO), followed by sinogenic infections and idiopathic central SBO. Multiparametric magnetic resonance (MR) and high-resolution CT are the mainstays for establishing a diagnosis and estimating disease extent, with MR being superior in ascertaining marrow and soft tissue involvement. Monitoring treatment response, of which imaging is a fundamental part, is challenging, with emerging promising imaging tools.

Keywords: CT; FDG-PET/CT; Gallium 67; MR imaging; Malignant otitis externa; Necrotizing otitis externa; Osteomyelitis; Skull base infection.

Publication types

  • Review

MeSH terms

  • Humans
  • Magnetic Resonance Imaging
  • Osteomyelitis* / diagnostic imaging
  • Otitis Externa*
  • Skull Base / diagnostic imaging
  • Tomography, X-Ray Computed