Premium
Role of diffusion‐weighted imaging in the discrimination of purulent intrasinusal content: A retrospective study
Author(s) -
Radulesco Thomas,
Scemama Ugo,
Mancini Julien,
Moulin Guy,
Dessi Patrick,
Michel Justin,
Varoquaux Arthur
Publication year - 2019
Publication title -
clinical otolaryngology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.914
H-Index - 68
eISSN - 1749-4486
pISSN - 1749-4478
DOI - 10.1111/coa.13388
Subject(s) - medicine , sinusitis , functional endoscopic sinus surgery , sinus (botany) , univariate analysis , magnetic resonance imaging , diffusion mri , paranasal sinuses , retrospective cohort study , nuclear medicine , nasal polyps , effective diffusion coefficient , ethmoid sinus , radiology , multivariate analysis , pathology , surgery , botany , biology , genus
Objectives The objective of this study was to analyse MRI with morphological (T1, T2) and diffusion sequences (DWI, b1000) in patients presenting non‐aggressive patterns of sinus opacity and operated on by functional endoscopic sinus surgery (FESS). Design A retrospective study. Setting Diffusion imaging in paranasal sinus pathology remains little known. To date, no imaging system is capable of determining the purulent content of a non‐enhanced sinus filling. Participants We included consecutive patients having undergone FESS in whom MRI of the paranasal sinuses was performed. Subjects were allocated to Case (pus) or Control (no pus) groups depending on sinus content found intraoperatively. FESS was performed for bacterial acute rhinosinusitis, acute exacerbations of chronic rhinosinusitis , non‐purulent sinusitis, naso‐sinusal polyposis, antrochoanal polyp, isolated polyp, angiomatous polyp and eosinophilic fungal sinusitis. Tumours, mucoceles and fungus balls were excluded. Main outcome measures We analysed T1, T2, b1000 and MRI sequences and ADC map. Results On univariate analysis, intermediate signal in T2 and high signal in b1000 were associated with Cases ( P < 0.001) as were low ADC values ( P < 0.001). The difference in mean ADC values between Cases and Controls was statistically significant (respectively, 0.518 vs 2.041 × 10 −3 mm 2 /sec, P < 0.01). On multivariate analysis, MRI with ADC < 0.725 × 10 −3 mm 2 /sec and b1000_SI > brain was significantly associated with the case group. MRI with b1000_SI < brain and ADC > 1.450 × 10 −3 mm 2 /sec was significantly associated with the control group. Conclusions Diffusion MRI offers extremely promising results regarding content characterisation of infectious sinus diseases.