A Radiological Profile of Fungal Sinusitis

Abstract

Objectives: To create a radiological profile of fungal sinusitis and determine the radiological differences between fungal and nonfungal sinusitis based on the presence of hyperattenuation, bony erosion, neo-osteogenesis, air-fluid level, and extrasinus extension.Methods: This is a retrospective, single-blind, case-control study involving the analysis of 119 computed tomography (CT) scans of the paranasal sinuses. Based on the histopathology, they were divided into cases comprising fungal sinusitis and controls of nonfungal sinusitis. Benign and malignant tumors and previously operated cases of fungal sinusitis were excluded from the study. The principal investigators were blinded to the diagnosis. The comparison parameters were hyperattenuation, the presence of air-fluid level, bone erosion, neo-osteogenesis, and extrasinus extension. Data was analyzed by Chi-square and Fischer exact t-test using SPSS 14.0 software and a p < 0.05 was considered significant. Results:Our study showed the presence of hyperattenuation, neo-osteogenesis, bone erosion, air-fluid level, extrasinus extension in 75.2%, 48.3%, 25.9%, 36.2%, and 6.9% of the cases and 13.1%, 16.4%, 6.6%, 9.8%, and 0 controls, respectively. All the parameters were statistically significant in cases when compared to controls. Conclusion:Hyperattenuation, neo-osteogenesis, air-fluid level, bone erosion, and extrasinus extension are the parameters on CT imaging that will help routinely assess and differentiate fungal sinusitis from nonfungal sinusitis with considerable accuracy, although, there is an overlap with malignancy when the parameter of bone erosion is considered as a differential diagnosis of chronic invasive fungal sinusitis. It reiterates the fact that history, clinical examination, and laboratory evaluation hold an important role in provisional diagnosis.

Preparation and Evaluation of Primary Reagents for the Radioimmunoassay of Hepatitis B Surface Antigen (HBsAg) for its Diagnosis in Human Sera

“…The three groups recorded the maximum immunoresponse after 3 weeks following the third booster. The present study's data on displacement and immune response align well with those of Pillai & Bhandarkar who postulated that, the production of antibodies increased significantly and at a faster rate upon encountering the same antigen twice [21] . Affinity of a potential antiserum was determined via the schatchard analysis of standard curve data according to the law of mass action established by Scatchard in 1949 [23,20] .…”

“…Dilution curve for each HBsAg standard concentration (0 or 100ng/ ml) was calculated as % bound of labeled antigen against different antiserum dilutions. In an optimized assay, the optimal antibody dilutions that provide the maximum displacement between zero and high standards were selected as the antibody titer [21] . Titer and displacement for each antiserum obtained from immunized rabbits were plotted as displacement % against different HBsAg -antibody dilutions.…”

Radiological Evaluation of Allergic Fungal Sinusitis: Novel Findings

“…Our current opinion, like Pillai et al, is that CT imaging alone will not be sufficient to accurately diagnose one subtype of fungal sinusitis, perhaps only helping us to differentiate it from non-fungal sinusitis. [15] Combined CT and MRI findings have also been reported to provide a radiographic appearance that is highly specific for AFS. [14] Our study has some limitations.…”

“…[14] However, recently there are opinions that radiological findings alone are not significant in the diagnosis of AFS. [15] Although Bent and Kuhn diagnostic criteria for AFS is extremely useful, according to the information that we have gained in recent years about AFS, this disease is much more common than expected in some parts of the world and there may be a need for a re-evaluation in the radiological diagnostic criteria due to increased number of diagnoses of AFS. [5] In our study, we aimed to investigate the presence of serrated turbinate, which is a new radiological finding that can help the diagnosis of AFS, and whether there is a difference between the radiological findings among AFS and non-AFS in our study.…”

Evaluation of Morphological Changes of the Paranasal Sinus in Computed Tomography and Magnetic Resonance Imaging Modalities

“…Computed tomography (CT) produces excellent bone detail and accurate soft-tissue mapping and is considered to provide the most accurate details of the extent of disease and that of anatomical conditions, thus providing basic landmarks for performing the surgery or further treatment [5]. The CT scan can delineate the changes occurring within PNS during the fungal and nonfungal sinusitis, thus giving the profile of the sinusitis [6]. On the other hand, because of the inherent soft-tissue contrast of magnetic resonance imaging (MRI), the secretions, thickened mucosa, and masses are better differentiated.…”