Hyperdense findings in sinus computed tomography of chronic rhinosinusitis

Our study investigated the diagnostic value of the mineralization findings and high-density secretion features of sinus computed tomography (CT) images in cases of chronic rhinosinusitis (CRS) compared to histopathology and operative findings.

This was a prospective cohort study of 193 patients consecutively enrolled for endoscopic sinus surgery (ESS). Group 1 had mineralization in the sinus; group 2 had high-density secretions in the sinus but no mineralization; group 3 lacked both high-density secretions and evidence of mineralization. Intergroup comparisons were performed for histopathology (especially presence of fungus ball), CT scores, and gross operative appearance.

Histopathologic evidence of fungus ball (FB) compared to presence of CT findings was significantly different between the groups, with the following percentages of patients demonstrating FB presence: 33% of group 1 (CT mineralization) (n = 48); 4% of group 2 (CT hyperdensity) patients (n = 25); and 2% of group 3 (no mineralization, no hyperdensity) patients (n = 120) (p < 0.05). Operative findings did not necessarily correlate with CT findings and all groups demonstrated varying amounts of dry cheesy (DCM) or wet clay-like (WCLM) material, though this was slightly higher in groups 1 and 2.

A preoperative survey of sinus mineralization and high-density secretion features observed with CT was predictive of operative findings and histopathological results indicating a sinus FB.