Computer‐assisted staging of chronic rhinosinusitis correlates with symptoms

Abstract

Objectives The Lund-Mackay (LM) staging system for Chronic Rhinosinusitis (CRS) does not correlate with clinical parameters, likely due to its coarse scale. We developed a “Modified Lund Mackay” (MLM) system, which uses a 3D, computerized method to quantify the volume of mucosal inflammation in the sinuses, and sought to determine whether the MLM would correlate with symptoms and disease-specific quality of life. Methods We obtained Total Nasal Symptom Score (TNSS) and Sinonasal Outcomes Test (SNOT-22) data from 55 adult subjects immediately prior to sinus imaging. The volume of each sinus occupied by mucosal inflammation was measured using MATLAB algorithms created using customized, image analysis software after manual outlining of each sinus. Linear regression was used to model the relationship between the MLM and SNOT-22 and TNSS. Correlation between the LM and MLM was tested using Spearman's rank correlation coefficient. Results Adjusting for age, gender, and smoking, a higher symptom burden was associated with increased sinonasal inflammation as captured by the MLM (β=0.453, p<0.013). As expected due to the differences in scales, the LM and MLM scores were significantly different (p<0.011). No association between MLM and SNOT-22 scores was found. Conclusions The MLM is one of the first imaging-based scoring systems that correlates with sinonasal symptoms. Further development of this custom software, including full automation and validation in larger samples, may yield a biomarker with great utility for both treatment of patients and outcomes assessment in clinical trials.

Objective and subjective assessment of outcomes after sinus surgery in sixty patients

“…Whereas preoperatively a majority of patients was categorised in class of severity IV (severe to highly severe symptoms) or III (moderate to severe symptoms), five to seven months after functional endoscopic sinus surgery (FESS) most patients improved to class I (no or mild symptoms) or class II (mild to moderate symptoms) most of the patients indicating good regeneration of the ostiometal complex after FESS. A positive correlation only between PNS and volume of the maxillary sinuses was observed, and this result is corroborated by another study 8 . In another study, the volumetric scoring system showed a higher correlation with improvement in scores for symptoms, endoscopic exam and quality of life as non-volumetric-based CT scores 10 .…”

“…In our study, postoperative scarring or adhesion formation at the ostium was not observed in most of the patients indicating good regeneration of the ostiometal complex after FESS. A positive correlation only between PNS and volume of the maxillary sinuses was observed, and this result is corroborated by another study. In another study, the volumetric scoring system showed a higher correlation with improvement in scores for symptoms, endoscopic exam and quality of life as non‐volumetric‐based CT scores.…”

“…This reflects the importance of outcomes that measure the subjective burden of disease rather than the survey of objective parameters. Several studies pointed out that there is a poor correlation between objective outcome measures such as volumetric analysis, nasal airflow or endoscopic classification to subjective selfassessment 4,7,8 . Similar to other studies 6 , we found that a large change in pneumatised maxillary volume does not lead to an increased improvement in primary nasal symptoms.…”

Three‐dimensional image analysis for staging chronic rhinosinusitis

“…All patients getting sinus scans had rhinologic complaints (such as congestions or post nasal drip), including 2 patients undergoing evaluation prior to stem cell transplantation. The first period represented subjects who were analyzed in our initial study 9 and who further met the LM ≥ 4 criterion (n=23). The second period added new subjects for the present study (n=22).…”

“…9 The Chicago modified Lund-Mackay (Chicago MLM) scoring system (previously referred to as “modified Lund-Mackay system” 9 ) uses specialized software to calculate the mucosa-to-sinus volume ratio through three-dimensional analysis of axial CT images. Unlike the LM system, the Chicago MLM system provides a quantitative and objective method to measure differing degrees of mucosal inflammation on a continuous scale from 0 to 1 (Figure 1).…”