A new approach to categorization of radiologic inflammation in chronic rhinosinusitis

Abstract

Chronic rhinosinusitis (CRS) is a prevalent condition. Clinical diagnosis requires subjective evidence (i.e. symptoms) and objective evidence of inflammation (e.g. sinus computed tomography [CT]). Few studies have assessed differences in common CT scoring approaches for CRS, the Lund-Mackay (LM) system and its modified version (mLM); none in a general population sample. The aims of this study were to answer the following: (1) Is mLM superior to LM? (2) Should nasal cavity opacification be included in scoring? (3) How should location-specific scores be utilized? (4) If location-specific scores are summed, what should be the cutoff? (5) Are associations of opacification with symptoms observed when using different measurement approaches? We scored sinus CTs using LM and mLM from 526 subjects selected from a larger CRS study. Exploratory factor analysis (EFA) assessed similarity of mLM and LM. Latent class analysis (LCA) identified subgroups of sinus opacification patterns. Factors associated with group membership and relations with nasal and sinus symptoms (NSS) guided clinical relevance. EFA suggested no differences between LM and mLM, or after addition of nasal cavity opacification. LCA identified three opacification groups: no/mild, localized, and diffuse. Males were 2.7x more likely to have diffuse opacification than females, as were those with asthma or hay fever. A LM cutoff of 3 had similar performance to the currently used 4. Diffuse opacification was associated with nasal blockage and smell loss. Differing patterns of opacification may be clinically relevant, improving measurement of objective evidence in studies of CRS and sinus diseases.

The Correlation Between the CT-Scan Scoring System and the SNOT-22 Score in Adult Chronic Rhinosinusitis

“…These factors can induce physiological nasal response which lead to increasing airway resistance, nasal irritation and congestion and rhinorrhea [10] . Thus, these changes was 2.7 times more likely to be seen in CT-scan as a diffuse opacity in male than female [11] .…”

Naso-sinus findings by computed tomography in pediatric chronic dacryocystitis

“…The results obtained in the group we studied drew our attention to the higher frequency of dacryocystitis and rhinosinusitis in boys and the higher prevalence of both conditions in the 3 to 6 years age group. Some studies suggest that women have a higher risk of chronic rhinosinusitis (CRS), with sex differences in the degree of opacification of paranasal sinuses 8,9 . Masculine sex has also been associated with higher scores, with 2.7 times more chances of experiencing diffuse sinus involvement compared to females 10 , as it was the cases of the present study, which requires further specific research.…”

Hallazgos nasosinusales por tomografía computada en dacriocistitis crónica pediátrica

“…Existen estudios que sugieren que las mujeres tienen mayor riesgo de rinosinusitis crónica (RSC), con diferencia por sexo en el grado de opacificación de los senos paranasales 8,9 . También se ha asociado el sexo masculino con puntuaciones más altas, con 2.7 veces más probabilidades de presentar afección difusa de los senos en comparación con las mujeres 10 , como se observó en el presente estudio, lo cual requiere mayores investigaciones específicas.…”

“…Esto concuerda con la literatura, en la que se refiere que las niñas presentan una menor probabilidad (OR: 0.81) 8,9 que los niños de presentar un valor alto de rinosinusitis bilateral de acuerdo con la escala de Lund-Mackay (p = 0.016). Los resultados sugieren que las niñas presentan menor probabilidad (OR: 0.2) de tener más de 12 puntos en la escala de Lund-Mackay (p = 0.054).…”