Chronic rhinosinusitis in allergic asthmatic patients: radiography versus low-dose computed tomography evaluation.
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.
Stelmach
Rafael
R
Pulmonary Division - InCor, University of São Paulo Medical School, São Paulo, Brazil. rafael.stelmach@incor.usp.br
Junior
Servulo Azevedo Dias
SA
Figueiredo
Claudia Maria
CM
Uezumi
Kiyomi
K
Genu
Ana Maria
AM
Carvalho-Pinto
Regina Maria
RM
Cukier
Alberto
A
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