Ryoo Inseon, Poésy Serena, Kaliaev Artem, Buch Karen, Sakai Osamu
From the Department of Radiology (I.R., S.P., A.K., O.S.), Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts.
Department of Radiology (I.R., K.B., O.S.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
AJNR Am J Neuroradiol. 2025 Feb 3;46(2):355-361. doi: 10.3174/ajnr.A8485.
Granulomatosis with polyangiitis (GPA) and eosinophilic granulomatosis with polyangiitis (EGPA) are the most common causes of chronic sinusitis from systemic granulomatous diseases. While both are small- to medium-sized vasculitis with necrotizing granulomas, they have different clinical courses and prognoses. High-density sinus opacification has been reported in allergic fungal sinusitis with eosinophilic infiltrates. Given that EGPA also has eosinophilic tissue infiltrates, we evaluated the differences in sinus CT findings, focusing on the sinus secretion attenuation between patients with GPA and EGPA, along with other previously described findings.
This study included 31 patients with GPA and 22 patients with EGPA who underwent sinus CT. The attenuation of secretions within the paranasal sinuses was visually assessed, and the Hounsfield unit (HU) of the highest-density portions within each sinus was measured. Lund-Mackay scores (LMS), bony destruction, sclerotic wall changes, adjacent organ involvement, and nasal polyps were evaluated and compared between patients with GPA and EGPA. Multiple logistic regression analyses were conducted to determine which factors independently discriminated GPA from EGPA, and the diagnostic ability to differentiate between these 2 diseases was evaluated by using a receiver operating characteristic curve analysis.
More patients in the GPA group showed bony destructions, bone sclerosis, and involvement of organs adjacent to paranasal sinuses than in the EGPA group ( = .006, 0.048, and 0.035, respectively). The EGPA group had higher LMS and more nasal polyps than the GPA group ( = .078 and 0.333, respectively). More patients in the EGPA group showed internal high-density opacification than in the GPA group, and patients with EGPA had higher mean HUs (both < .0001). The presence of high-density opacification or mean HUs independently distinguished GPA from EGPA (OR, 53.67 and 1.07; 95% CI, 4.07-708.03 and 1.02-1.13, respectively) and showed a greater ability to discriminate between these diseases compared with other findings.
Patients with EGPA had more high-density sinus opacification and higher mean HU on sinus CT than the patients with GPA. In addition to the previously reported CT findings, such as bony destruction, bone sclerosis, and adjacent organ involvement, evaluating secretion attenuation can assist in distinguishing between GPA and EGPA.
肉芽肿性多血管炎（GPA）和嗜酸性肉芽肿性多血管炎（EGPA）是系统性肉芽肿性疾病导致慢性鼻窦炎的最常见病因。虽然二者均为伴有坏死性肉芽肿的中小血管炎，但临床病程和预后不同。已有报道称变应性真菌性鼻窦炎伴有嗜酸性粒细胞浸润时鼻窦呈高密度混浊。鉴于EGPA也有嗜酸性粒细胞组织浸润，我们评估了鼻窦CT表现的差异，重点关注GPA和EGPA患者鼻窦分泌物的衰减情况以及其他先前描述的表现。
本研究纳入了31例接受鼻窦CT检查的GPA患者和22例EGPA患者。通过视觉评估鼻旁窦内分泌物的衰减情况，并测量每个鼻窦内最高密度部分的亨氏单位（HU）。对GPA和EGPA患者的Lund-Mackay评分（LMS）、骨质破坏、骨壁硬化改变、邻近器官受累情况及鼻息肉进行评估和比较。进行多因素逻辑回归分析以确定哪些因素能独立区分GPA和EGPA，并通过绘制受试者工作特征曲线分析评估这两种疾病的诊断能力。
与EGPA组相比，GPA组更多患者出现骨质破坏、骨硬化及鼻旁窦邻近器官受累（分别为P = 0.006、0.048和0.035）。EGPA组的LMS更高，鼻息肉更多（分别为P = 0.078和0.333）。与GPA组相比，EGPA组更多患者出现鼻窦内高密度混浊，且EGPA患者的平均HU更高（均P < 0.0001）。高密度混浊或平均HU的存在可独立区分GPA和EGPA（OR分别为53.67和1.07；95%CI分别为4.07 - 708.03和1.02 - 1.13），与其他表现相比，其区分这两种疾病的能力更强。
与GPA患者相比，EGPA患者鼻窦CT上有更多的高密度鼻窦混浊及更高的平均HU。除了先前报道的CT表现，如骨质破坏、骨硬化及邻近器官受累外，评估分泌物衰减有助于区分GPA和EGPA。
