Columbus, OH - September 2016
Sinus disease is common in patients with cystic fibrosis (CF), and computed tomography (CT) is often used to assess the condition. But the most widely used systems for scoring CT scans do a poor job of determining sinus disease severity in CF patients; those systems don’t take into account several CF-specific findings.
Beyond that issue, the scoring systems are often complicated, requiring a neuroradiologist to interpret scores – and even then, clinical and radiological findings do not correlate well.
So physician-researchers at Nationwide Children’s Hospital have created and validated a new scoring system that uses parameters applicable to CF-related sinus disease and is easily understandable for most clinicians. A recent publication in the Annals of Otology, Rhinology & Laryngology describes the system for use in adults, but an upcoming paper will apply it to children as well.
“In the past, we have really just looked at CT scans or x-rays and tried to determine severity based on clinical experience because scoring systems don’t work for us,” says Shahid I. Sheikh, MD, lead author of the publication, and a member of the Section of Pulmonary Medicine and Cystic Fibrosis Center at Nationwide Children’s. “We thought it would be important to develop a scoring system that does work in CF patients.”
Five CT findings are considered on each side of the sinuses, for a total of ten: maxillary opacification, nasal cavity obstruction, displacement of lateral nasal wall in the middle meatus, expansion of any sinuses (mucocele) and uncinated process absence or demineralization. Maxillary opacification and nasal cavity obstruction are scored on a 0-3 scale based on severity; the others are scored 0 or 1 based on absence or presence.
To validate the scale, a pulmonologist, a radiologist and an ENT specialist reviewed CT scans of 69 adults diagnosed with CF and a control group of age-matched patients. The doctors were blinded to patient identity, and reviewed each person’s scans on two separate occasions, one month apart.
The intrarater reliability ranged from .70 to 1.00 across the ten CT parameters. Interrater reliability ranged from .55 to 1.00, with 80 percent of observations in the .70 to 1.00 range.
“We believe that this system can be used by any specialty with equal ease,” says Dr. Sheikh, who is also an associate professor of Clinical Pediatrics at The Ohio State University College of Medicine. “This can give us the opportunity to look at changes in sinus disease severity over time, especially before and after lung transplant and other surgeries when sinus disease is of great significance.”
Drs. Sheikh and Lind intend to do that in the future with prospective studies to test the effectiveness of the new scoring system.
Sheikh SI, Handly B, Ryan-Wenger NA, Hayes D Jr, Kirkby SE, McCoy KS, Lind M. Novel computed tomography scoring system for sinus disease in adults with cystic fibrosis. Annals of Otology, Rhinology & Laryngology. 2016 Jun 29. [Epub ahead of print]