Holme Sigrun Skaar, Moen Jon Magnus, Kilian Karin, Haukeland Hilde, Molberg Øyvind, Eggesbø Heidi B
Division of Radiology and Nuclear Medicine, Oslo University Hospital, PB 4950 Nydalen, Oslo, 0424, Norway.
Institute of Clinical Medicine, University of Oslo, PB 1072 Blindern, Oslo, 0316, Norway.
BMC Med Imaging. 2019 Feb 4;19(1):13. doi: 10.1186/s12880-019-0315-7.
Even though progressive rhinosinusitis with osteitis is a major clinical problem in granulomatosis with polyangiitis (GPA), there are no studies on how GPA-related osteitis develops over time, and no quantitative methods for longitudinal assessment. Here, we aimed to identify simple and robust CT-based methods for capture and quantification of time-dependent changes in GPA-related paranasal sinus osteitis and compare performance of the methods under study in a largely unselected GPA cohort.
GPA patients (n = 121) with ≥3 paranasal CT scans obtained ≥12 months apart and control patients not having GPA or rhinosinusitis (n = 15) were analysed by: (i) Global osteitis scoring scale (GOSS), originally developed for chronic rhinosinusitis; (ii) Paranasal sinus volume by manual segmentation; (iii) Mean maxillary and sphenoid diameter normalised to landmark distances (i.e. diameter ratio measurement, DRM).
Time-dependent changes in GPA-related osteitis were equally well measured by the simple DRM and the labour-intensive volume method while GOSS missed ongoing changes in cases with extensive osteitis. GOSS at last CT combined with DRM identified three distinct patient groups: (i) The no osteitis group, who had no osteitis and no change in DRM from baseline CT to last CT (45/121 GPA patients and 15/15 disease controls); (ii) Stable osteitis group, with presence of osteitis, but no change in DRM across time (31 GPA); (iii) Progressive osteitis, defined by declining DRM (45 GPA).
We suggest DRM and GOSS as complementary methods for capturing, classifying and quantifying time-dependent changes in GPA-related osteitis.
尽管进行性鼻窦炎伴骨炎是肉芽肿性多血管炎（GPA）中的一个主要临床问题，但尚无关于GPA相关骨炎如何随时间发展的研究，也没有纵向评估的定量方法。在此，我们旨在确定基于CT的简单且可靠的方法，以捕捉和量化GPA相关鼻旁窦骨炎随时间的变化，并在一个基本未经过筛选的GPA队列中比较所研究方法的性能。
对间隔≥12个月获得≥3次鼻旁CT扫描的GPA患者（n = 121）和无GPA或鼻窦炎的对照患者（n = 15）进行分析：（i）最初为慢性鼻窦炎开发的全球骨炎评分量表（GOSS）；（ii）通过手动分割测量鼻旁窦体积；（iii）将上颌骨和蝶骨的平均直径标准化为地标距离（即直径比测量，DRM）。
简单的DRM和劳动强度大的体积法对GPA相关骨炎随时间的变化测量效果相同，而GOSS在广泛骨炎的病例中遗漏了持续的变化。最后一次CT时的GOSS与DRM相结合确定了三个不同的患者组：（i）无骨炎组，无骨炎且从基线CT到最后一次CT的DRM无变化（45/121例GPA患者和15/15例疾病对照）；（ii）稳定骨炎组，存在骨炎，但DRM随时间无变化（31例GPA患者）；（iii）进行性骨炎组，由DRM下降定义（45例GPA患者）。
我们建议将DRM和GOSS作为互补方法，用于捕捉、分类和量化GPA相关骨炎随时间的变化。
