Volumetric computed tomography analysis of the olfactory cleft in patients with chronic rhinosinusitis

Abstract

Background Commonly used computed tomography (CT) staging systems for chronic rhinosinusitis (CRS) focus on the sinuses and do not quantify disease in the olfactory cleft. The goal of the current study was to determine whether precise measurements of olfactory cleft opacification better correlate with olfaction in patients with CRS. Methods Olfaction was assessed using the 40-item Smell Identification Test (SIT-40) before and after sinus surgery in adult patients. Olfactory cleft opacification was quantified precisely using three-dimensional, computerized volumetric analysis, as well as via a semi-quantitative Likert scale estimations at predetermined anatomic sites. Sinus opacification was also quantified using the Lund-Mackay staging system. Results The overall cohort (n=199) included 89 (44.7%) patients with CRS with nasal polyposis (CRSwNP) and 110 (55.3%) with CRS without nasal polyposis (CRSsNP). The olfactory cleft opacified volume correlated with objective olfaction as determined by the SIT-40 (Rs= −0.461; p<0.001). The correlation was significantly stronger in the CRSwNP subgroup (Rs= −0.573; p<0.001), whereas no appreciable correlation was found in the CRSsNP group (Rs= −0.141; p=0.141). Correlations between sinus-specific Lund-Mackay CT scoring and SIT-40 scores were weaker in the CRSwNP (Rs= −0.377; p<0.001) subgroup but stronger in the CRSsNP (Rs= −0.225; p=0.018) group when compared to olfactory cleft correlations. Greater intra-class correlations (ICC) were found between quantitative volumetric measures of olfactory cleft opacification (ICC=0.844; p<0.001) as compared with semi-quantitative Likert grading (ICC=0.627; p<0.001). Conclusions Quantitative measures of olfactory cleft opacification correlate with objective olfaction, with the strongest correlations seen in patients with nasal polyps.

Automated classification of osteomeatal complex inflammation on computed tomography using convolutional neural networks

“…As a result, the literature regarding correlation of these CT scoring systems and patient-reported outcomes has been mixed 8 . Interestingly, more recent studies using semi-automated volumetric analysis of CT scans have shown a higher degree of association with symptoms 9,10 , suggesting that more comprehensive methods of CT image analysis may be important for linking symptoms with objective measures of inflammation. These methods, however, are time-consuming and may not be practical for routine clinical use.…”

“…Briefly, a CNN is a biologically-inspired computer algorithm that uses thousands of simple units, modeled after neurons, that take an input from one layer of units, perform a mathematical transformation, and feed the output to the next set of neurons. Similar to their biological counterparts, while each individual neuron is simple to understand, structured networks of them have demonstrated complicated, emergent properties that are useful for pattern-recognition tasks 9,10 . These algorithms have been used to great effect in multiple applications 11 , most notably the ImageNet challenge, an annual international computer vision competition that asks computer scientists to develop algorithms to classify a given set of images into over 1,000 categories.…”

Nasal Symptom Questionnaire: Our Proposed Scoring System and Prognostic Factors in Chronic Rhinosinusitis

“…Productivity loss from CRS rivals that of other chronic disease processes such as asthma, diabetes, and heart diseases [15, 16]. CRS is typically classified into 2 types: CRS with nasal polyps (NP) and CRS without NP [17-19]. Clinical features of CRS with NP with eosinophil-dominant inflammation as “eosinophilic CRS (ECRS)” were first reported in Japan in 2001 [20].…”

Chronic Rhinosinusitis-Related Smell Loss: Medical and Surgical Treatment Efficacy

“…18–20 However, in CRS patients who already demonstrate a decreased quality of life, it appears that olfactory dysfunction does not have an additional negative additive effect. 21 Among patients with CRS, those with nasal polyposis, eosinophilia, asthma, smoking, and increased age are more likely to demonstrate decreased olfactory function.…”