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Paranasal sinus opacification‐to‐pneumatization ratio applied as a rapid and validated clinician assessment
Author(s) -
Marino Michael J.,
Riley Charles A.,
Patel Amit S.,
Pou Jason D.,
Kessler Raymond H.,
McCoul Edward D.
Publication year - 2017
Publication title -
international forum of allergy and rhinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.503
H-Index - 46
eISSN - 2042-6984
pISSN - 2042-6976
DOI - 10.1002/alr.21833
Subject(s) - medicine , sinus (botany) , paranasal sinuses , chronic rhinosinusitis , frontal sinus , inter rater reliability , nuclear medicine , coronal plane , paranasal sinus diseases , intra rater reliability , kappa , computed tomography , radiology , surgery , confidence interval , statistics , rating scale , botany , mathematics , biology , genus , linguistics , philosophy
Background The utility of clinician‐applied instruments, particularly the Lund‐Mackay score, in the assessment of paranasal sinus computed tomography (CT) in chronic rhinosinusitis (CRS) remains incompletely defined. The purpose of this study was to determine if a new approach to the evaluation of sinus CT could accurately predict the extent of opacification while remaining simple for clinician use. Methods Twenty‐four sinus CT scans were measured for the percent of sinus opacification using three‐dimensional (3D) volumetric analyses. The same scans were also evaluated using the Lund‐Mackay score to measure opacification and the Assessment of Pneumatization of the Paranasal Sinuses (APPS) score to measure total sinus volume (TSV). Correlation analysis was performed for the Lund‐Mackay to APPS score ratio as a predictor of percent opacification. Validation analysis was also performed to determine the optimal orientation for Lund‐Mackay scoring, which has not previously been described. Results The Lund‐Mackay to APPS score ratio was very strongly correlated with the percentage of sinus opacification measured by 3D volumetric analysis ( r = 0.862, r 2 = 0.743, p < 0.001). Lund‐Mackay scoring was not statistically different between axial‐only, coronal‐only, or triplanar groups for interrater ( p = 0.379) and intrarater reliability ( p = 0.312). Conclusion The Lund‐Mackay score is validated for rater reliability in multiple orientations. Using the APPS score as a measure of TSV, the Lund‐Mackay‐to‐APPS ratio very strongly correlates with the percentage of sinus opacification by 3D volumetric analysis. Further study will be required to determine if this ratio is predictive of symptom severity.