Abstract
Objective
(1) To develop an objective method for quantifying radiologic bone erosion in allergic fungal rhinosinusitis (AFRS). (2) To assess the utility of the newly developed AFRS CT staging system in differentiating AFRS patient groups.
Methods
Patients from two tertiary care rhinology practices with classic AFRS and available CTs (2001–2007) were included for retrospective review. CTs were scored by trained graders not involved in the patients’ care as the primary treating surgeon. The following novel assessment scale was used: Each paranasal sinus wall with expansion/erosion was scored 1 point, with a maximum of 3 points possible for each frontal sinus, 2 points for each ethmoid complex, 3 points for each sphenoid sinus, 3 points for each maxillary sinus, 1 point for the frontal intersinus septum, and 1 point for the sphenoid intersinus septum, yielding a maximum of 24 possible total points.
Results
111 CTs were reviewed. Mean score across all patients was 7.8 (range 0–24). Males scored significantly higher than females (mean 9.3 vs 5.6, p < 0.001). African Americans scored significantly higher than Caucasians (mean 9.6 vs 5.0, p < 0.001). There was also a trend towards younger patients exhibiting higher scores (p = 0.07).
Conclusions
A radiologic grading system for bone erosion/expansion in AFRS is presented, which is easy to apply and may objectively stratify disease severity. Males and African Americans with AFRS demonstrate significantly more bone erosion. Additional analysis of disease course will assess the potential utility of this staging system in predicting outcomes.
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