title: Chronic rhinosinusitis in allergic asthmatic patients: radiography versus low-dose computed tomography evaluation.
abstract: OBJECTIVE
  Chronic rhinosinusitis (CRS) is a risk factor for asthma exacerbations and is associated with greater clinical severity. Discrepancies may exist between CRS clinical diagnosis and data from paranasal sinus (PS) X-ray or computed tomography (CT) scans. The objective was to compare PS involvement using low-dose CT and plain X-ray in allergic asthmatic patients with rhinitis.
  
  
  METHODS
  Patients underwent PS radiography in the frontal and mentonian positions and low-dose CT consisting of six to eight coronal scans performed on the central region of the sphenoidal, ethmoidal, maxillary, and frontal sinuses. Possible results for each sinus were a normal aspect or the presence of mucosal thickening, opacification, and/or air-fluid level.
  
  
  RESULTS
  Eighty-five (93.4%) of 91 study patients had radiological changes on radiography or CT. In only six (6.6%) were both tests normal. The maxillary was the most involved sinus by both methods. Simultaneous PS abnormalities were observed in 40.5% on X-ray and 56.7% on CT. For the frontal, ethmoidal, and sphenoidal sinuses, the proportion of normal results differed significantly between X-ray and CT: 80.2% versus 89%, 76.9% versus 63.7% and 96.7% versus 70.3%, respectively (p <.05). Agreement was over 70% for the maxillary and frontal sinuses. CT also provided a better diagnosis of air-fluid level changes than X-ray.
  
  
  CONCLUSIONS
  Low-dose CT significantly showed larger number of normal PS results and diagnosed more severe PS lesions. As the determination of true sinus severity lesion impacts in asthma control, low-dose CT may replace PS plain X-ray and conventional CT to support better clinical decisions.
authors.affiliation: Pulmonary Division - InCor, University of São Paulo Medical School, São Paulo, Brazil. rafael.stelmach@incor.usp.br
authors.forename: Rafael
authors.initials: R
authors.lastname: Stelmach
authors.forename: Servulo Azevedo Dias
authors.initials: SA
authors.lastname: Junior
authors.forename: Claudia Maria
authors.initials: CM
authors.lastname: Figueiredo
authors.forename: Kiyomi
authors.initials: K
authors.lastname: Uezumi
authors.forename: Ana Maria
authors.initials: AM
authors.lastname: Genu
authors.forename: Regina Maria
authors.initials: RM
authors.lastname: Carvalho-Pinto
authors.forename: Alberto
authors.initials: A
authors.lastname: Cukier
mesh_terms: D000328:Adult; D001249:Asthma / Q000150:complications / Q000000981:diagnostic imaging* / Q000276:immunology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D010256:Paranasal Sinuses / Q000000981:diagnostic imaging* / Q000276:immunology*; D012220:Rhinitis / Q000150:complications / Q000000981:diagnostic imaging* / Q000276:immunology; D016037:Single-Blind Method; D012852:Sinusitis / Q000150:complications / Q000000981:diagnostic imaging* / Q000276:immunology; D011795:Surveys and Questionnaires; D014057:Tomography, X-Ray Computed / Q000379:methods; D055815:Young Adult