Nasal endoscopy: an adjunct to patient selection for preoperative low-dose CT examination in chronic rhinosinusitis

Abstract

Objectives: The growing awareness of increased X-ray exposure to the public has led to the propagation of several methods for reducing the radiation dose during CT examination. Lowdose CT protocols do not, however, have an established role in pre-operative evaluation. The aim of this article was to assess the usefulness of nasal endoscopy in the selection of patients under pre-operative care for low-dose CT examination. Methods: A cadaver head was used to discover institutional minimum acceptable CT image quality and scanning settings. Then, 134 adult patients with chronic rhinosinusitis (CRS) were enrolled into the study and divided randomly into standard dose (120 kVp, 100 mAs) or lowdose CT groups (120 kVp, 45 mAs). Subjective assessment of the diagnostic image quality of the surgically relevant anatomical structures was compared using a five-point scale (from excellent to unacceptable) by a radiologist and sinus surgeon independently. Pathologic states of the nose were quantified according to the Lund-Kennedy endoscopic system (LKES) and Lildholdt's scale. Results: Image quality was similar in low-dose and standard dose groups in patients without polyps. The quality of 13% of scans from patients with polyps from the low-dose group and 4% from the standard dose group was in the range from moderate to poor. The quality of scans obtained with low milliamperes second (mAs) values worsened in patients with polyps in the middle meatus, but the difference was particularly pronounced compared with standard dose among subjects with Lildholdt's score above 2 ( p , 0.001). Correlation with LKES revealed that changes other than polyps (i.e. discharge, oedema, scaring or crusting) in the nasal cavity alone do not affect the image quality. Interobserver agreement in both groups was very high. Conclusions: Low-dose scanning should be promoted as the screening imaging method of choice in patients with suspected CRS. Furthermore, low mAs value examination can be performed pre-operatively without fear of significant image quality deterioration in uncomplicated CRS patients without polyps, or with minor changes in nasal endoscopy. Standard dose CT, which provides a better identification of bony landmarks, minimizes diagnostic errors and risk to patients, so it might be considered in those with polyps below the middle turbinate.

ACR Appropriateness Criteria ® Sinonasal Disease

“…CBCT imaging may be utilized for the assessment of sinus anatomy and pathology in uncomplicated cases of sinusitis, although it has limitations in assessing soft-tissue structures, and it may aid in the diagnosis of odontogenic sinusitis, which may occur when periapical infections spread from the molar teeth into the floor of the maxillary sinus and may be the etiology of maxillary sinusitis in about 10% to 12% of patients [40,41]. Appropriateness for patient selection may be made either clinically or by endoscopy [42].…”

Standard-dose versus low-dose multidetector computed tomography examinations in patients with uncontrolled chronic rhinosinusitis

“…[23] Radiation dose is an important issue for diagnostic modalities. [2,8,24] The mean radiation dose faced by patients of sdMDCT (calculated as per ALARA protocol [4] ) would be created eye lens opacification and malignant tumor of thyroid gland of patients in future because only 6–14 Gy radiation dose is quite enough to form cataract in human [24] and 0.0075 Gy radiation exposure may be caused malignant neoplasms of thyroid. [8] With respect to a radiation dose of MDCT techniques adopted in the trial, preoperative low-dose MDCT protocols with acceptable image quality would be the safest option for sinus surgeries.…”

“…Preoperative low-dose MDCT is also applied for sinus surgery because this surgery is relatively safe surgery but has the issue of consistency of intraoperative radiological findings. [2] Moreover, low-dose protocols could be used for sinus surgeries in the cases when patients have no polyps or have small changes in nasal endoscopy [4] because if sinus surgery performed with reference to low-dose protocols there would be chances of postoperative asthma and the polyp score. [5] Postoperative complications affected by the other factors like the experience of surgeons, length of surgeries, and the demographic characters of patients.…”

Tissue Interleukin-33: A Novel Potential Regulator of Innate Immunity and Biomarker of Disease Severity in Chronic Rhinosinusitis with Nasal Polyps

“…High blood eosinophilia was defined as having values of over 5% of total white blood cells. Data from the quality-oflife SNOT-22 questionnaire, endoscopy scores, and polyp sizes rated using the Lildholdt scale [12] were recorded (Table 2).…”