2018 Section 5 - Rhinology and Allergic Disorders

Reprinted by permission of Int Forum Allergy Rhinol. 2017; 7(11):1052-1057.

OR I G I NAL ART I CLE

Three-dimensional image analysis for staging chronic rhinosinusitis Sooyoung Lim, BA 1 , Michael V. Ramirez, BS 1 , Jonathan C. Garneau, BS 1 , Megan K. Ford, BS 2 , Katherine McKeough, BS 3 , Daniel T. Ginat, MD 2 , Fuad M. Baroody, MD 3 , Samuel G. Armato III, PhD 2 and Jayant M. Pinto, MD 3,4

Background: Traditional methods of staging chronic rhinos- inusitis (CRS) through imaging do not differentiate between degrees of partial mucosal sinus inflammation, thus limit- ing their utility as imaging biomarkers. We hypothesized that so ware-aided, quantitative measurement of sinus in- flammation would generate a metric of disease burden that would correlate with clinical parameters in patients with suspected sinus disease. Methods: Adults with rhinologic complaints undergoing computed tomography imaging were recruited at an urban, academic, tertiary care center (n = 45 with Lund-Mackay [LM] scores 4). Three-dimensional (3D) volumetric image analysis was performed using a semiautomated method to obtain a “Chicago-modified Lund-Mackay” (Chicago MLM) score, which provides a continuous scale to quantify ex- tent of opacification. Linear regression was used to test the association of the Chicago MLM score with concur- rent symptoms (Total Nasal Symptom Score [TNSS]) and disease-specific quality of life, based on the Sinonasal Out- come Test-22 (SNOT-22). Results: Chicago MLM scores were significantly associ- ated with both symptoms ( p = 0.037) and disease-specific 1 Pritzker School of Medicine, University of Chicago, Chicago, IL; 2 Department of Radiology, University of Chicago, Chicago, IL; 3 Section of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of Chicago, Chicago, IL; 4 Center on Demography and Economics of Aging, University of Chicago, Chicago, IL Correspondence to: Jayant M. Pinto, MD, Department of Surgery, University of Chicago, 5841 S. Maryland Avenue, MC 1035, Chicago, IL 60637; e-mail: jpinto@surgery.bsd.uchicago.edu Additional Supporting Information may be found in the online version of this article. Current affiliations: M.R., Department of Internal Medicine, Northshore University Health System, Chicago, IL; J.C.G.: Department of Otolaryngology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY; M.K.F.: Division of Allergy and Immunology, Department of Pediatrics, Nemours/A.I. duPont Hospital for Children, Wilmington, DE and Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, PA Funding sources for the study: M.R., J.G., and S.L.: Pritzker School of Medicine’s Summer Research and Scholarship and Discovery Programs; National Institute on Aging (AG036762); National Institute of Allergy and

quality of life ( p = 0.007). Inflammation in the ethmoid and sphenoid sinuses appeared to influence these associ- ations. These findings were even more robust when anal- ysis was limited to patients with more severe disease (LM > 6). Conclusion: The quantitative measurement of sinus in- flammation by computer-aided 3D analysis correlates mod- estly with both symptoms and disease-specific quality of life. Posterior sinuses appear to have the greatest impact on these findings, potentially providing an anatomic target for clinicians to base therapy. The Chicago MLM score is a promising imaging biomarker for clinical and research use. C 2017 ARS-AAOA, LLC. Key Words: biomarkers; paranasal sinus diseases; quality of life; sinusi- tis; spiral computed tomography How to Cite this Article : Lim S, Ramirez M, Garneau JC, et al. Three-dimensional image analysis for staging chronic rhinosinusitis. Int Forum Allergy Rhinol . 2017;7:1052–1057. C hronic rhinosinusitis (CRS) is a highly prevalent air- way disease affecting 1 in 8 adults in the United States, with a large associated economic burden. 1 This disorder has major adverse effects on patient quality of life and signifi- cantly hinders patients’ daily activities and social function. 2 However, despite its public health impact, there are no well- defined biomarkers of CRS, a barrier that inhibits research Infectious Disease (Chronic Rhinosinusitis Integrated Studies Program AI106683); University of Chicago Institute for Translational Medicine via the National Center for Advancing Translational Sciences (5UL1 TR 000430-09) Potential conflict of interest: S.G.A.: royalties and licensing fees through the University of Chicago for computer-aided diagnosis technology. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Presented at the 2016 American Academy of Allergy, Asthma & Immunology Annual Meetings, on March 6, 2016, in Los Angeles, CA. Received: 1 April 2017; Revised: 13 August 2017; Accepted: 22 August 2017 DOI: 10.1002/alr.22014 View this article online at wileyonlinelibrary.com.

International Forum of Allergy & Rhinology, Vol. 7, No. 11, November 2017

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