Traditional methods of staging Chronic Rhinosinusitis (CRS) do not differentiate between degrees of partial mucosal sinus inflammation limiting their utility as biomarkers. We hypothesized that software-aided quantitative measurement of sinus inflammation would generate a metric of disease burden that would correlate with clinical parameters in symptomatic patients.
Adults with rhinologic complaints undergoing CT imaging were recruited at an urban, academic, tertiary care center (n=47 with Lund MacKay [LM] scores>4). 3D volumetric image analysis was performed using a validated, semi-automated method yielding a Modified Lund MacKay (MLM) score (which allowed for a continuous scale to quantitate opacification). We then used linear regression (in R) to test the association of the MLM with concurrent symptoms (total nasal symptom scores [TNSS]) and disease specific quality of life (Sinonasal Outcome Test-22 [SNOT-22]).
MLM scores were significantly associated with both symptoms (β=0.482, P=0.025) and disease specific quality of life (β=0.077, P=0.004). These relationships were not affected by age, sex, race, smoking, season, atopy status, or smoking. Inflammation in the ethmoid and sphenoid sinuses appeared to drive these associations. These findings were even more robust when we limited our analyses to patients with more severe disease (LM>6).
We demonstrate that a more precise and quantitative measurement of sinus inflammation by computer-aided 3D analysis correlates modestly with both symptoms and, for the first time, disease specific quality of life. Posterior sinuses appear to drive these findings, providing an anatomic target for clinicians to base therapy. The MLM is a promising imaging biomarker for clinical and research use.