Kandukuri Rashmi, Phatak Suresh
Resident, Department of Radio-diagnasis, Datta Meghe Institute of Medical Sciences University , Sawangi, Wardha, Maharashtra, India .
Professor and Head of Department, Department of Radio-diagnasis, Datta Meghe Institute of Medical Sciences University , Sawangi, Wardha, Maharashtra, India .
J Clin Diagn Res. 2016 Nov;10(11):TC09-TC12. doi: 10.7860/JCDR/2016/23197.8826. Epub 2016 Nov 1.
Computed Tomography (CT) plays an important diagnostic role in patients with sinonasal diseases and determines the treatment. The CT images clearly show fine structural architecture of bony anatomy thereby determining various anatomical variation, extent of disease and characterization of various inflammatory, benign and malignant sinonasal diseases.
To evaluate sensitivity and specificity of CT in diagnosis of sinonasal diseases and to characterise the benign and malignant lesions with the help of various CT parameters. Also, to correlate findings of CT with histo-pathological and diagnostic nasal endoscopy/ Functional Endoscopic Sinus Surgery (FESS) findings.
In this hospital based prospective study 175 patients with symptomatic sinonasal diseases were evaluated by clinical diagnosis and 16 slice Multi Detector Computed Tomography (MDCT). The details of findings of nasal endoscopy, Functional Endoscopic Sinus Surgery (FESS), histopathological examination and fungal culture were collected in all those cases where those investigations were done. All those findings were correlated with CT findings and statistical analysis was done by using Test statistics (sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV) and accuracy), Chi-Square test and Z-test for single proportions. Software used in the analysis was SPSS 17.0 version and graph pad prism 6.0 version and p < 0.05 was considered as statistically significant.
CT diagnosis had higher sensitivity, specificity, PPV and NPV in diagnosing various sinonasal diseases in comparison to clinical diagnosis. On correlating CT diagnosis with final diagnosis, congenital conditions have 100% sensitivity and specificity. Chronic sinusitis has 98.3% sensitivity and 97.8% specificity. For fungal sinusitis the sensitivity was 60% and specificity was 99.3%. Polyps have sensitivity of 94.4% and specificity of 98.1%. Benign neoplasms have sensitivity of 90.9% and specificity of 99.2%, malignant neoplasms have sensitivity of 94.1% and specificity of 99.3%. The p-value in all instances was <0.05, i.e. <0.0001 indicating the significance of the findings.
CT is the modality of choice in imaging the sinonasal region for evaluating various congenital, inflammatory, benign and malignant pathologies and associated complications thereby planning the further management of the patient. CT is the best modality of choice for evaluating the bone erosion or destruction. The potential pitfalls to differentiate on CT are fungal sinusitis and dense secretions.
计算机断层扫描（CT）在鼻窦疾病患者的诊断中发挥着重要作用，并决定治疗方案。CT图像能清晰显示骨质结构的精细架构，从而确定各种解剖变异、疾病范围以及各种炎症性、良性和恶性鼻窦疾病的特征。
评估CT在鼻窦疾病诊断中的敏感性和特异性，并借助各种CT参数对良性和恶性病变进行特征描述。此外，将CT检查结果与组织病理学及诊断性鼻内镜检查/功能性内镜鼻窦手术（FESS）结果进行关联。
在这项基于医院的前瞻性研究中，对175例有症状的鼻窦疾病患者进行了临床诊断和16层螺旋计算机断层扫描（MDCT）检查。在所有进行了鼻内镜检查、功能性内镜鼻窦手术（FESS）、组织病理学检查和真菌培养的病例中，收集了相关检查结果的详细信息。将所有这些结果与CT检查结果进行关联，并使用检验统计量（敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和准确性）、卡方检验和单比例Z检验进行统计分析。分析中使用的软件为SPSS 17.0版本和GraphPad Prism 6.0版本，p<0.05被认为具有统计学意义。
与临床诊断相比，CT诊断在诊断各种鼻窦疾病时具有更高的敏感性、特异性、PPV和NPV。将CT诊断结果与最终诊断结果进行关联后发现，先天性疾病的敏感性和特异性均为100%。慢性鼻窦炎的敏感性为98.3%，特异性为97.8%。真菌性鼻窦炎的敏感性为60%，特异性为99.3%。鼻息肉的敏感性为94.4%，特异性为98.1%。良性肿瘤的敏感性为90.9%，特异性为99.2%，恶性肿瘤的敏感性为94.1%，特异性为99.3%。所有情况下的p值均<0.05，即<0.0001，表明研究结果具有显著性。
CT是对鼻窦区域进行成像以评估各种先天性、炎症性、良性和恶性病变及相关并发症从而规划患者进一步治疗方案的首选方式。CT是评估骨质侵蚀或破坏的最佳选择方式。在CT上难以鉴别的潜在问题是真菌性鼻窦炎和浓稠分泌物。
