Repeated sinus CT imaging after recent head imaging

OBJECTIVES

Excessive use of sinus CT is a significant problem in medical imaging, resulting in unnecessary costs and radiation exposure. This study assesses frequency of sinus CT performed after recent head imaging has already adequately evaluated the sinuses.

METHODS

A retrospective search of the PACS database of an academic medical center was performed to identify cases of sinus CT imaging in 2017. Cases were excluded if sinus CT was performed related to trauma, tumor, operative evaluation, or acute infection other than sinusitis (orbital cellulitis, intracranial abscess). Studies with separate imaging covering the sinuses ordered at the same time as sinus CT or performed previously within 4 weeks were identified and clinical information was recorded.

RESULTS

Of 735 sinus CTs performed, 19 (5%) had same-day head imaging and 30 (8%) had previous head imaging within 4 weeks, adding up to a cumulative 13% of cases with recent head imaging. The average patient age was 42, with 13 pediatric cases. Of ordering providers, residents ordered the highest percentage of sinus CTs with same-day head imaging (84%) and previous imaging within 4 weeks (63%). The sinuses were described in all head CT radiology reports, while 10 of 12 brain MRI reports did not mention the sinuses.

CONCLUSION

In one year, 13% of patients receiving sinus CTs at our institution had recent head imaging. A focused education effort for ordering providers to avoid repeating sinus imaging, and for radiology to comment on sinuses on head imaging, may reduce unnecessary sinus CTs.

[Analysis of factors affecting olfactory disfunctions in patients with chronic rhinosinusitis with nasal polyps]

Objective: To analyze the factors affecting olfactory disfunctions in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). Methods: This was a retrospective analysis. Eighty-eight patients with CRSwNP who underwent endoscopic sinus surgery in Beijing Anzhen Hospital from 2014 to 2018 were enrolled, including 22 males and 66 females, with the age of (48.1±11.3) years old(Mean±SD). Sniffin' Sticks olfactory test, Lund-Mackay score and modified sinus CT olfactory cleft score, nasal resistance and acoustic reflex examination, blood routine and blood biochemistry test, serum specific IgE test were performed before surgery and nasal polyps of all patients were collected for eosinophil count during surgery. According to bilateral total TDI score, the patients were divided into normal olfactory function group and olfactory disfunction group. The clinical baseline data were compared between the two groups. According to the results of single factor analysis, factors which were significant different between the two groups and clinically useful indicators were further included in the multivariate Logistic regression model analysis, then a model predicting olfactory disfunction in patients with CRSwNP was initially established. P<0.05 was considered statistically significant. Results: Among 88 patients with CRSwNP, 32 (36.4%) patients were with normal olfaction and 56 (63.6%) patients were with olfactory disfunction, including 40 (45.5%) of hyposmia and 16 (18.2%) of anosmia. Tissue eosinophil count, blood eosinophil percentage and blood urea concentration had significant difference between the two groups (12.7[2.0, 52.3]/HP (M[P(25), P(75)]) vs 38.6[16.2, 87.0]/HP, 2.75[1.60, 4.80]% vs 4.35[2.50, 6.60]%, (5.56±1.15) mmol/L vs (4.98±1.33) mmol/L, all P<0.05). Modified sinus CT olfactory cleft score and Lund-Mackay score except for ostiomeatal complex score were statistically significant between the two groups (all P<0.05). Multivariate Logistic regression analysis showed that the bilateral and total olfactory cleft score and blood urea concentration were statistically significant, in addition, the bilateral and total olfactory cleft score was a risk factor (OR=2.108, 95%CI: 1.407-3.159, P<0.001) and blood urea within a certain concentration was a protective factor (OR=0.461, 95%CI: 0.240-0.884, P=0.020). Further studies found that the area under the ROC curve of the model with tissue eosinophil count, blood eosinophil percentage, bilateral and total olfactory cleft score, total inspiratory volume and blood urea concentration was 0.888 (P<0.01), which had good predictive value for olfactory disorders in CRSwNP. Conclusions: The modified sinus CT olfactory cleft score is closely related to the olfactory disorders in patients with CRSwNP. A certain degree of elevated blood urea concentration may have a protective effect on the olfactory function of patients with CRSwNP.

Bronchial wall thickening is associated with severity of chronic rhinosinusitis

BACKGROUND

Though the relationship between chronic rhinosinusitis (CRS) and lower airway diseases is well recognized, the impact of CRS on bronchial wall structure has not been elucidated. Here, we evaluated the bronchial wall structure of CRS patients with or without diagnosed airway diseases by three-dimensional computed tomography (3D-CT).

METHODS

Subjects who underwent both chest CT and sinus CT within a year were recruited from consecutive medical records. CRS was defined as a Lund-Mackay score (LMS) of over 5 points. Airway dimensions were measured using validated software. Standard blood tests and pulmonary function tests were performed, and their correlation with airway thickness was examined.

RESULTS

One-hundred-seventy-two patients were recruited (93 CRS subjects and 79 non-CRS subjects). The bronchial walls of CRS subjects were significantly thicker than those of non-CRS subjects. CRS and asthma were related to bronchial wall thickening by multivariate linear regression analysis adjusted for age, smoking status, and chest symptoms. In addition, LMS was significantly correlated with bronchial wall thickening.

CONCLUSION

Airway walls in CRS subjects were thicker than those in non-CRS subjects and associated with the severity of CRS. These data indicate strong relationship between upper and lower airways regardless of chest symptoms or diagnosed airway diseases.