title: Computer-assisted staging of chronic rhinosinusitis correlates with symptoms.
abstract: BACKGROUND
  The Lund-Mackay (LM) staging system for chronic rhinosinusitis (CRS) does not correlate with clinical parameters, likely due to its coarse scale. We developed a "Modified Lund Mackay" (MLM) system, which uses a three-dimensional (3D), computerized method to quantify the volume of mucosal inflammation in the sinuses, and sought to determine whether the MLM would correlate with symptoms and disease-specific quality of life.
  
  
  METHODS
  We obtained Total Nasal Symptom Score (TNSS) and 22-item Sino-Nasal Outcome Test (SNOT-22) data from 55 adult subjects immediately prior to sinus imaging. The volume of each sinus occupied by mucosal inflammation was measured using MATLAB algorithms created using customized, image analysis software after manual outlining of each sinus. Linear regression was used to model the relationship between the MLM and the SNOT-22 and TNSS. Correlation between the LM and MLM was tested using Spearman's rank correlation coefficient.
  
  
  RESULTS
  Adjusting for age, gender, and smoking, a higher symptom burden was associated with increased sinonasal inflammation as captured by the MLM (β = 0.453, p < 0.013). As expected due to the differences in scales, the LM and MLM scores were significantly different (p < 0.011). No association between MLM and SNOT-22 scores was found.
  
  
  CONCLUSIONS
  The MLM is one of the first imaging-based scoring systems that correlates with sinonasal symptoms. Further development of this custom software, including full automation and validation in larger samples, may yield a biomarker with great utility for both treatment of patients and outcomes assessment in clinical trials.
authors: Pritzker School of Medicine, The University of Chicago.
authors: Jonathan
authors: J
authors: Garneau
authors: Pritzker School of Medicine, The University of Chicago.
authors: Michael
authors: M
authors: Ramirez
authors: Department of Radiology, The University of Chicago.
authors: Samuel G
authors: SG
authors: Armato
authors: Department of Radiology, Florida Hospital.
authors: William F
authors: WF
authors: Sensakovic
authors: Department of Radiology, The University of Chicago.
authors: Megan K
authors: MK
authors: Ford
authors: Department of Radiology, The University of Chicago.
authors: Colin S
authors: CS
authors: Poon
authors: Department of Radiology, The University of Chicago.
authors: Daniel T
authors: DT
authors: Ginat
authors: Department of Radiology, The University of Chicago.
authors: Adam
authors: A
authors: Starkey
authors: Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, The University of Chicago.
authors: Fuad M
authors: FM
authors: Baroody
authors: Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, The University of Chicago.
authors: Jayant M
authors: JM
authors: Pinto
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D007249:Inflammation / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009297:Nasal Mucosa / Q000473:pathology; D011788:Quality of Life; D012107:Research Design; D012220:Rhinitis / Q000000981:diagnostic imaging* / Q000473:pathology; D012852:Sinusitis / Q000000981:diagnostic imaging* / Q000473:pathology; D014057:Tomography, X-Ray Computed
keywords: Lund-Mackay; chronic sinusitis symptoms; computed tomography; computer-assisted image analysis; quality of life; sinonasal; sinusitis