Chronic rhinosinusitis symptoms and computed tomography staging: improved correlation by incorporating radiographic density

Abstract

Incorporation of radiographic characteristics of sinus opacification with Lund-Mackay scores offers greater predictive power of patients' subjective symptom severity.

Computer‐assisted staging of chronic rhinosinusitis correlates with symptoms

“…The significant correlation between patient symptoms and the MLM score makes MLM one of only a few scoring systems that has demonstrated such a relationship [15, 16, 27]. The MLM system benefits from its objective nature and continuous scale.…”

“…Prior work has investigated the relationship among mucosal thickening on imaging, endoscopy findings on physical exam, and symptom severity in patients with severe CRS [15, 16, 27] and has focused on improving correlation between CT findings and symptom scores for patients with a narrow spectrum of severe disease defined by strict criteria. In contrast, the patients included in the present study were not confined to those with CRS and had relatively low burden of sinus inflammation (mean LM score of 3.9 relative to previous studies with an average LM score of 4.3 in patients without CRS and 9.8 in patients with CRS [28, 29]).…”

“…Therefore, weak correlation between CT-based staging systems and patient symptoms could be the result of less important sinuses being weighted the same as more influential sinuses; perhaps a weighted model based on anatomic location would improve imaging correlation with clinical symptoms. Indeed, Sedaghat et al [27] described a weighted model for radiologic assessment of the paranasal sinuses and found (with a technique that did not involve volumetric analysis) that although Hounsfield unit (HU) values and LM scores alone were not correlated with symptoms, an HU-weighted LM scoring system was correlated with symptoms. Software tools may make a volumetric weighted model feasible and strengthen correlation between MLM scores and symptom severity, but future studies with a more comprehensive assessment of all paranasal sinuses targeted at proposed weighted models are necessary to support this idea.…”

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

“…Some have tried to identify predictive data from CT scans, and have noted that presence of osteoneogenesis on CT is associated with diminished QoL gains after surgery, 78 and also that intrasinus quantity and density of opacification may correlate with QoL measures. 79 Although both endoscopic and radiographic measures may be further refined in the future to better correlate with QoL measures and outcomes, it seems clear that they are not measuring exactly the same constructs, and failure to identify a high level of correlation with symptoms does not imply that the measure is not useful. Future research might identify other factors that predict outcome, such as measures of immune response and regulation and the status of the microbiome.…”

Three‐dimensional image analysis for staging chronic rhinosinusitis

“…7 Sedaghat and Bhattacharyya incorporated Hounsfield units into LM scores in an attempt to better utilize density information from the CT images. 8 Both studies found that image scores better correlated with some (but not all) of the symptoms, suggesting the superiority of the objective software-based systems to subjective, visual scoring systems.…”