Development of CT-based methods for longitudinal analyses of paranasal sinus osteitis in granulomatosis with polyangiitis

Holme, Sigrun Skaar; Moen, Jon Magnus; Kilian, Karin; Haukeland, Hilde; Molberg, Øyvind; Eggesbø, Heidi B.

doi:10.1186/s12880-019-0315-7

Cited by 10 publications

(25 citation statements)

References 24 publications

(26 reference statements)

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“…Both extensive bone osteoneogenesis (osteitis) and destructions seen in GPA imaging are used to assess disease activity even though little is known about CT or MRI findings that may indicate poor prognosis [19]. Sinonasal surgery in GPA is debated [20] and may cause increased osteoneogenesis (Figure 14a-c).…”

Section: Systemic Diseasesmentioning

confidence: 99%

Imaging in Sinonasal Disorders

Eggesbø¹

2020

Dysfunction of Olfactory System [Working Title]

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Computed tomography (CT) is the "working horse" in sinonasal imaging and should always be the first choice. Magnetic resonance imaging (MRI) is complementary to CT when complications to rhinosinusitis or neoplasm are suspected. Imaging of the paranasal sinuses is common due to stuffy nose. In order to correct interpretation, proper imaging technique as well as knowledge of bony anatomy and variants and mucosal incidental findings are of outmost importance. Acute rhinosinusitis is very common and does not need imaging unless complications are suspected. In chronic rhinosinusitis, a CT examination is needed to find the cause and site of the mucociliary obstruction and to rule out other causes as odontogenic and fungal sinusitis and neoplasms.

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Section: Systemic Diseasesmentioning

confidence: 99%

Imaging in Sinonasal Disorders

Eggesbø¹

2020

Dysfunction of Olfactory System [Working Title]

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“…We have described details on the GPA patient cohort in previous paranasal CT studies [12,13]. Briefly, the cohort included all the GPA patients from the Norwegian systemic vasculitis and connective tissue disease registry (NOSVAR), a consentbased patient registry run by the Department of Rheumatology at Oslo University Hospital, who met the following pre-specified inclusion criteria: (I) clinical ANCA vasculitis classifiable as GPA according to the European Medicines Agency (EMA) algorithm [14], (II) at least two sets of archived sinus CT scans available for analysis, with minimum one year between time of baseline CT and time of last CT.…”

Section: Gpa Patient Cohort and Study Timelinementioning

confidence: 99%

“…We scored CRS-related CT features by scoring systems developed for CRS assessment as previously described [12]. Briefly, we assessed mucosal thickening or fluid (mucosal disease) by Lund-Mackay score (LM-score) [17], where a completely clear sinus is scored as 0 and a completely opacified sinus as 2, and all degrees of mucosal disease in between are scored as 1.…”

Section: Evaluation and Scoring Of Crs-related Ct Findingsmentioning

confidence: 99%

“…We followed the osteitis trajectories of the cohort, and in line with our two previous studies [12,13], we stratified the patients into three groups based on the osteitis development over time: (I) no osteitis, (II) stable osteitis and (III) progressive osteitis. Specific to this study, the patients were stratified by osteitis severity at the end of study observation, using a modification of the GOSS severity grading proposed by Georgalas et al [18].…”

Section: Evaluation and Scoring Of Crs-related Ct Findingsmentioning

confidence: 99%

“…Recently, we developed and applied methods suitable for evaluation of serial paranasal sinus CT scans of GPA patients. We used these methods to assess time-dependent CRS changes, with thickening of the bones of the sinus walls as the main surrogate marker for sinus damage [12,13].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Impact of Baseline Clinical and Radiological Features on Outcome of Chronic Rhinosinusitis in Granulomatosis with Polyangiitis

Holme¹,

Kilian²,

Eggesbø³

et al. 2020

Preprint

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Background: Granulomatosis with polyangiitis (GPA) causes a recurring inflammation in nose and paranasal sinuses that clinically resembles chronic rhinosinusitis (CRS) of other aetiologies. While sinonasal inflammation is not among the life-threatening features of GPA, patients report it to have major negative impact on quality of life. A relatively large proportion of GPA patients have severe CRS with extensive damage to nose and sinus structures evident by CT, but risk factors for severe CRS development remain largely unknown. In this study, we aimed to identify clinical and radiological predictors of CRS-related damage in GPA. Methods: We included GPA patients who had clinical data sets from time of diagnosis, and two or more paranasal sinus CT scans obtained ≥ 12 months apart available for analysis. We defined time from first to last CT as the study observation period, and evaluated CRS development across this period by CT scores for inflammatory sinus bone thickening (osteitis), bone destructions and sinus opacifications (here defined as mucosal disease). In logistic regression, we applied osteitis as main outcome measure for CRS-related damage.Results: We evaluated 697 CT scans obtained over median 5 years observation from 116 GPA patients. We found that 39% (45/116) of the GPA patients remained free from CRS damage across the study observation period, while 33% (38/116) had progressive damage. By end of observation, 32% (37/116) of the GPA patients had developed severe osteitis. We identified mucosal disease at baseline as a predictor for osteitis (Odds Ratio 1.34), and we found that renal involvement at baseline was less common in patients with severe osteitis at last CT (41%, 15/37) than in patients with no osteitis (60%, 27/45). Conclusions: In this largely unselected GPA patient cohort, baseline sinus mucosal disease associated with CRS-related damage, as measured by osteitis at end of follow-up. We found no significant association with clinical factors, but the data set indicated an inverse relationship between renal involvement and severe sinonasal affliction.

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Impact of Paranasal Sinus Surgery in Granulomatosis With Polyangiitis: A Longitudinal Computed Tomography Study

et al. 2020

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Objectives/Hypothesis Severe chronic rhinosinusitis (CRS) in patients with granulomatosis with polyangiitis (GPA) failing medical therapies can be treated with paranasal sinus surgery. Whether this surgery protects from progressive sinonasal damage remains unknown. Here, we aimed to analyze time‐dependent relations between sinus surgeries and computed tomography (CT) imaging features in the CRS of GPA. Study Design Longitudinal observational study. Methods We assessed CRS features including bone thickening by global osteitis scoring scale, bone erosions, and mucosal thickening by Lund‐Mackay scores in serial paranasal sinus CT scans (742 CT scans in total) from a cohort of 127 well‐characterized GPA patients. Data on sinonasal surgical procedures were from a mandatory national registry and from chart review. We defined the time from baseline CT to last CT as the study observation period in each patient. Datasets were analyzed by linear mixed models. Results We found that 23/127 cohort patients had one or more paranasal sinus surgical procedures, and 96% of these (22/23) had osteitis by CT after surgery. In patients with nasal surgery alone or no surgery, we identified osteitis in 7/11 (64%) and 45/93 (48%), respectively. During the observation period of a median of 5 years, 38 patients had progression of their sinus osteitis, with the highest annual osteitis progression rates observed around the time of surgery. Conclusions In this cohort, paranasal sinus surgery was associated with prevalence, severity, and progression rate of sinus osteitis, indicating that sinus surgery does not reduce the bone damage development in the CRS of GPA. Level of Evidence 4 Laryngoscope, 130: E460–E468, 2020

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Development of CT-based methods for longitudinal analyses of paranasal sinus osteitis in granulomatosis with polyangiitis

Cited by 10 publications

References 24 publications

Imaging in Sinonasal Disorders

Imaging in Sinonasal Disorders

Impact of Baseline Clinical and Radiological Features on Outcome of Chronic Rhinosinusitis in Granulomatosis with Polyangiitis

Impact of Paranasal Sinus Surgery in Granulomatosis With Polyangiitis: A Longitudinal Computed Tomography Study

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