Evaluation of the Usefulness of CT in the Diagnosis of Unilateral Sinus Disease

Amano Yuta, Takeda Kazuya, Hayama Masaki, Maeda Yohei, Tsuda Takeshi, Akazawa Hitoshi, Obata Sho, Nakatani Ayaka, Kawashima Takayuki, Inohara Hidenori

doi:10.7248/jjrhi.59.132

<p>Background: Differential diagnosis of unilateral sinus disease is diverse and the treatment depends on the exact disease. An appropriate preoperative diagnosis is particularly important for planning a surgical strategy. Paranasal sinus CT may assist the clinician in making a correct diagnosis for a unilateral sinus disease, but the utility of this method has not been fully established, and there is no clear evidence for which cases require paranasal sinus MRI for diagnosis, in addition to CT. Objective: The goal of the study was to evaluate the utility and limitations of paranasal sinus CT for diagnosis of unilateral sinus disease. Methods: DICOM forms with paranasal sinus CT data were prepared for five cases of unilateral sinus disease, which were diagnosed as odontogenic maxillary sinusitis (2 cases), 1 case of chronic sinusitis (1 case), allergic fungal rhinosinusitis (1 case), and inverted papilloma (1 case), respectively. The CT data and questionnaires were given to the 15 otorhinolaryngologists, including 8 specialists and 7 residents. Using the CT images, the expected diagnoses were made by distributing 100 points among seven categories: chronic sinusitis, paranasal sinus mycosis, allergic fungal rhinosinusitis, odontogenic maxillary sinusitis, inverted papilloma, malignant tumor, and others, based on the level of importance of paranasal sinus MRI findings for diagnosis of each case. Results: The median scores for the correct diagnoses were 40, 5, 20, 30, and 40 points, respectively. A comparison of these scores for diagnoses by specialists and residents in the five cases and in total gave p-values of 0.91, 0.81, 0.06, 0.68, 0.03, and 0.13, respectively. Among the 75 diagnoses (15 subjects × 5 cases), there were 71 in which use of MRI was thought to be necessary. Conclusion: The clinical utility of paranasal sinus CT is widely accepted, but our study shows that it is insufficient to use sinus CT information only to diagnose unilateral sinus diseases. The limitations of CT are widely known, and MRI was found to be important for diagnosis. Further studies are needed to define the utility of CT and indications for MRI.</p>

Evaluation of the Usefulness of CT in the Diagnosis of Unilateral Sinus Disease

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