2016 Section 5 Green Book

OR I G I NAL ART I CLE

Computer-assisted staging of chronic rhinosinusitis correlates with

symptoms

Jonathan Garneau, MD

, Michael Ramirez, BS

, Samuel G. Armato III, PhD

, William F. Sensakovic, PhD

Megan K. Ford, MD

, Colin S. Poon, MD, PhD, FRCPC

, Daniel T. Ginat, MD

, Adam Starkey, BS

Fuad M. Baroody, MD

and Jayant M. Pinto, MD

Background:

The Lund-Mackay (LM) staging system for

chronic rhinosinusitis (CRS) does not correlate with clin-

ical parameters, likely due to its coarse scale. We devel-

oped a “Modified Lund Mackay” (MLM) system, which uses

a three-dimensional (3D), computerized method to quan-

tify 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 cus-

tomized, image analysis so ware a er manual outlining of

each sinus. Linear regression was used to model the rela-

tionship 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 (

0.453,

0.013). As expected due to the differences in scales, the LM

and MLM scores were significantly different (

0.011). No

association between MLM and SNOT-22 scores was found.

Conclusion:

The MLM is one of the first imaging-based

scoring systems that correlates with sinonasal symptoms.

Further development of this custom so ware, 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.

2015 ARS-

AAOA, LLC.

Key Words:

sinusitis; chronic sinusitis symptoms; computed tomogra-

phy; computer-assisted image analysis; quality of life; Lund-

Mackay; sinonasal

How to Cite this Article:

Garneau J, Ramirez M, Armato SG III, et al. Computer-

assisted staging of chronic rhinosinusitis correlates with

symptoms.

Int Forum Allergy Rhinol

. 2015;5:637–642.

hronic rhinosinusitis (CRS) is a highly prevalent dis-

ease posing a substantial economic burden on the

Pritzker School of Medicine, The University of Chicago, Chicago, IL;

Department of Radiology, The University of Chicago, Chicago, IL;

Department of Radiology, Florida Hospital, Orlando, FL;

Section of

Otolaryngology–Head and Neck Surgery, Department of Surgery, The

University of Chicago, Chicago, IL

Correspondence to: Jayant M. Pinto, MD, The University of Chicago, 5841 S.

Maryland Ave., MC 1035, Chicago, IL 60637; e-mail:

jpinto@surgery.bsd.uchicago.edu

Current affiliation of Jonathan Garneau: Department of

Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at

Mount Sinai, New York, NY.

Current affiliation of Megan K. Ford: Department of Internal Medicine,

Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA.

Current affiliation of Colin S. Poon: Department of Radiology, Orillia

Soldiers’ Memorial Hospital, Orillia, ON, Canada.

Jonathan Garneau and Michael Ramirez contributed equally to this work.

Funding sources for the study: M.R. and J.G. were supported by the Pritzker

School of Medicine; J.G. received funding from the Icahn School of

Medicine; J.M.P. received funding from the National Institute on Aging and

healthcare system.

Although significant effort has been

devoted to investigating its pathophysiologic basis, efficacy

of various therapies, and utility of diagnostic tools such as

imaging and endoscopy, our understanding of these areas

remains limited. A major barrier to progress in developing

the National Institute of Allergy and Infectious Disease (AG036762;

AI106683); the study was also supported in part by a Preclinical Pilot

Translational Study Award from The University of Chicago Institute for

Translational Medicine (UL1TR000430).

The content is solely the responsibility of the authors and does not

necessarily represent the official views of the National Institutes of Health.

Potential conflict of interest: S.G.A. receives royalties and licensing fees for

computer-aided diagnosis technology through the University of Chicago.

All other authors declare no conflicts of interest.

Presented orally at the Annual ARS Meeting at the American Academy of

Otolaryngic Allergy Annual Meeting on September 20, 2014, Orlando, FL.

Received: 19 September 2014; Revised: 28 November 2014; Accepted:

1 January 2015

DOI: 10.1002/alr.21499

View this article online at

wileyonlinelibrary.com.

International Forum of Allergy & Rhinology, Vol. 5, No. 7, July 2015

Reprinted by permission of Int Forum Allergy Rhinol. 2015; 5(7):637-642.