Three‐dimensional volumetric computed tomographic scoring as an objective outcome measure for chronic rhinosinusitis: clinical correlations and comparison to Lund‐Mackay scoring

Abstract

Background We aimed to test the hypothesis that 3-D volume-based scoring of computed tomographic (CT) images of the paranasal sinuses was superior to Lund-Mackay CT scoring of disease severity in chronic rhinosinusitis (CRS). We determined correlation between changes in CT scores (using each scoring system) with changes in other measures of disease severity (symptoms, endoscopic scoring, and quality of life) in patients with CRS treated with triamcinolone. Methods The study group comprised 48 adult subjects with CRS. Baseline symptoms and quality of life were assessed. Endoscopy and CT scans were performed. Patients received a single systemic dose of intramuscular triamcinolone and were reevaluated 1 month later. Strengths of the correlations between changes in CT scores and changes in CRS signs and symptoms and quality of life were determined. Results We observed some variability in degree of improvement for the different symptom, endoscopic, and quality-of-life parameters after treatment. Improvement of parameters was significantly correlated with improvement in CT disease score using both CT scoring methods. However, volumetric CT scoring had greater correlation with these parameters than Lund-Mackay scoring. Conclusion Volumetric scoring exhibited higher degree of correlation than Lund-Mackay scoring when comparing improvement in CT score with improvement in score for symptoms, endoscopic exam, and quality of life in this group of patients who received beneficial medical treatment for CRS.

Computer‐assisted staging of chronic rhinosinusitis correlates with symptoms

“…The results of this study are consistent with a growing trend in the literature that demonstrates the potential utility of volumetric assessment for staging sinus disease [13, 14, 16]. The goal of the present study was to develop a computerized approach to the CT-based volumetric quantification of sinonasal mucosal inflammation in order to enhance the utility of imaging for staging CRS.…”

“…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]).…”

“…Likness et al [15] compared image-based CRS scoring systems by using volumetric calculations from CT scans as an objective measure of inflammation. Pallanch et al [16] compared quantitative measurements of inflammation to symptoms and endoscopic examination findings.…”

Three‐dimensional image analysis for staging chronic rhinosinusitis

“…Pallanch et al correlated changes in the percent of sinus opacification before and after triamcinolone treatment with changes in symptoms and endoscopic findings. 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.…”