TY - JOUR
T1 - A new approach to categorization of radiologic inflammation in chronic rhinosinusitis
AU - Kuiper, Jordan R.
AU - Hirsch, Annemarie G.
AU - Bandeen-Roche, Karen
AU - Sundaresan, Agnes S.
AU - Tan, Bruce K.
AU - Kern, Robert C.
AU - Schleimer, Robert P.
AU - Schwartz, Brian S.
N1 - Publisher Copyright:
© 2020 Kuiper et al.
PY - 2020/6
Y1 - 2020/6
N2 - Chronic rhinosinusitis (CRS) is a prevalent condition. Clinical diagnosis requires subjective evidence (i.e. symptoms) and objective evidence of inflammation (e.g. sinus computed tomography [CT]). Few studies have assessed differences in common CT scoring approaches for CRS, the Lund-Mackay (LM) system and its modified version (mLM); none in a general population sample. The aims of this study were to answer the following: (1) Is mLM superior to LM (2) Should nasal cavity opacification be included in scoring (3) How should location-specific scores be utilized (4) If location-specific scores are summed, what should be the cutoff (5) Are associations of opacification with symptoms observed when using different measurement approaches We scored sinus CTs using LM and mLM from 526 subjects selected from a larger CRS study. Exploratory factor analysis (EFA) assessed similarity of mLM and LM. Latent class analysis (LCA) identified subgroups of sinus opacification patterns. Factors associated with group membership and relations with nasal and sinus symptoms (NSS) guided clinical relevance. EFA suggested no differences between LM and mLM, or after addition of nasal cavity opacification. LCA identified three opacification groups: no/mild, localized, and diffuse. Males were 2.7x more likely to have diffuse opacification than females, as were those with asthma or hay fever. A LM cutoff of 3 had similar performance to the currently used 4. Diffuse opacification was associated with nasal blockage and smell loss. Differing patterns of opacification may be clinically relevant, improving measurement of objective evidence in studies of CRS and sinus diseases.
AB - Chronic rhinosinusitis (CRS) is a prevalent condition. Clinical diagnosis requires subjective evidence (i.e. symptoms) and objective evidence of inflammation (e.g. sinus computed tomography [CT]). Few studies have assessed differences in common CT scoring approaches for CRS, the Lund-Mackay (LM) system and its modified version (mLM); none in a general population sample. The aims of this study were to answer the following: (1) Is mLM superior to LM (2) Should nasal cavity opacification be included in scoring (3) How should location-specific scores be utilized (4) If location-specific scores are summed, what should be the cutoff (5) Are associations of opacification with symptoms observed when using different measurement approaches We scored sinus CTs using LM and mLM from 526 subjects selected from a larger CRS study. Exploratory factor analysis (EFA) assessed similarity of mLM and LM. Latent class analysis (LCA) identified subgroups of sinus opacification patterns. Factors associated with group membership and relations with nasal and sinus symptoms (NSS) guided clinical relevance. EFA suggested no differences between LM and mLM, or after addition of nasal cavity opacification. LCA identified three opacification groups: no/mild, localized, and diffuse. Males were 2.7x more likely to have diffuse opacification than females, as were those with asthma or hay fever. A LM cutoff of 3 had similar performance to the currently used 4. Diffuse opacification was associated with nasal blockage and smell loss. Differing patterns of opacification may be clinically relevant, improving measurement of objective evidence in studies of CRS and sinus diseases.
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U2 - 10.1371/journal.pone.0235432
DO - 10.1371/journal.pone.0235432
M3 - Article
C2 - 32598351
AN - SCOPUS:85087326340
SN - 1932-6203
VL - 15
JO - PloS one
JF - PloS one
IS - 6
M1 - e0235432
ER -