Killeen Daniel E, Sedaghat Ahmad R, Cunnane Mary E, Gray Stacey T
Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA.
Am J Rhinol Allergy. 2014 Nov-Dec;28(6):483-6. doi: 10.2500/ajra.2014.28.4104.
High-density paranasal sinus opacities are often deemed consistent with fungal elements. No studies of objective quantitative radiographic density measures have been performed to support this assertion.
A consecutive series of 120 patients with chronic rhinosinusitis who underwent maxillary antrostomy with microbiological evaluation of contents within 60 days of sinus computed tomography scanning was investigated. Radiographic density characteristics of opacities in cultured maxillary sinuses (minimum, maximum, average, and standard deviation of Hounsfield units [HUstd]) were recorded. Receiver operator characteristic (ROC) curves were used to analyze the accuracy of radiographic characteristics in predicting fungal opacities.
Of 133 maxillary sinus opacities, 22 were ultimately consistent with noninvasive fungal disease: 11 allergic fungal rhinosinusitis and 11 fungal balls. Fungal balls had higher-density components and were more heterogeneous and allergic fungal mucin was generally more radiodense. These findings were reflected by statistically significant ROC curves for maximum HU (p = 0.019) and HUstd (p = 0.023) for fungal balls and for average HU (p = 0.002) for allergic fungal mucin. A maximum HU cutoff of 334.0 detected fungal balls with 90.9% sensitivity and 72.7% specificity. An average HU cutoff of 42.9 HU detected allergic fungal mucin with 100% sensitivity and 46.3% specificity, although specificity improved to 73.2% with inclusion of nasal polyposis as a second requirement.
Higher average HU more accurately predicts allergic fungal mucin whereas heterogeneity/high-density components more accurately predict fungal balls. No objective radiographic density measure, in isolation, is both sensitive and specific in predicting noninvasive fungal sinusitis.
高密度鼻窦混浊通常被认为与真菌成分相符。尚未进行客观定量放射密度测量研究来支持这一论断。
对连续120例慢性鼻窦炎患者进行研究，这些患者在鼻窦计算机断层扫描60天内接受了上颌窦切开术，并对内容物进行了微生物学评估。记录培养的上颌窦混浊的放射密度特征（亨氏单位[HUstd]的最小值、最大值、平均值和标准差）。采用受试者操作特征（ROC）曲线分析放射学特征预测真菌性混浊的准确性。
在133例上颌窦混浊中，22例最终符合非侵袭性真菌病：11例变应性真菌性鼻窦炎和11例真菌球。真菌球具有更高密度的成分且更不均匀，变应性真菌黏液通常放射密度更高。这些发现通过真菌球的最大HU（p = 0.019）和HUstd（p = 0.023）以及变应性真菌黏液的平均HU（p = 0.002）的统计学显著ROC曲线得到反映。最大HU截断值为334.0时，检测真菌球的灵敏度为90.9%，特异度为72.7%。平均HU截断值为42.9 HU时，检测变应性真菌黏液的灵敏度为100%，特异度为46.3%，尽管将鼻息肉作为第二个条件纳入后特异度提高到了73.2%。
更高的平均HU能更准确地预测变应性真菌黏液，而异质性/高密度成分能更准确地预测真菌球。单独的客观放射密度测量在预测非侵袭性真菌性鼻窦炎时既不敏感也不特异。
