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A proposal for analyzing the inflammatory and remodeling processes of mucosa in chronic rhinosinusitis with nasal
Débora de Carvalho Garcez1, Miguel Soares Tepedino2, Debora Petrungaro Migueis3
1Universidade Federal de São Paulo, Departamento de Otorrinolaringologia-Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil; Universidade do Estado do Rio de Janeiro, Hospital Universitário Pedro Ernesto, Rio de Janeiro, RJ, Brazil.
Objectives:
Chronic Rhinosinusitis with Nasal Polyposis (CRSwNP) is a disease characterized by chronic inflammation and tissue remodeling process. The remodeling process in nasal polyps has mainly been studied by histology analysis. However, it is limited to a polyp fragment and requires tissue removal. The present study aims to evaluate the ability of Magnetic Resonance Imaging (MRI) to depict and characterize the remodeling process in patients with CRSwNP.
Methods:
30 patients that met clinical diagnostic criteria for CRSwNP, without previous history of rhinosinusitis surgery were submitted to MRI scan (conventional, diffusion-weighted and DCE MRI) and compared with polyp tissue histological findings, IL-6 concentrations in the tissue and eosinophil count in the blood. The examinations were evaluated, independently, by two radiologists blinded to other radiological and histological data. The pathologist, blinded to MRI results, also compared the tissue sample from the most central and the most peripheral portion of the polypoid tissue adjacent to the floor of the nasal fossa.
Results:
This study demonstrated a characteristic pattern of nasal polyps, whose peripheral portions of nasal polypoid tissue are edematous, whereas the central portions in the middle meatus and in the middle and upper ethmoid are predominantly fibrotic. ADC values found in the most anterior portion of the polyps may be a marker for radiological phenotyping the remodeling process. This non-invasive analysis presented a high degree of agreement in the fibrosis and edema rating by two radiologists and the histological analysis was concordant with the MRI findings. The polyps were characterized as eosinophilic, and no relationship was found between the severity of the eosinophilic inflammatory process or concentration of IL-6 and the remodeling process.
Conclusion:
MRI by using T2-weighted imaging sequence and ADCs values allows tissue characterization and is an effective tool for the differentiation of edematous and fibrotic components in CRSwNP.
Insights
Magnetic Resonance Imaging (MRI) can differentiate between edematous and fibrotic tissues in Chronic Rhinosinusitis with Nasal Polyposis (CRSwNP). This non-invasive method aids in characterizing the remodeling process within nasal polyps.
Area of Science:
- Otorhinolaryngology
- Radiology
- Pathology
Background:
- Chronic Rhinosinusitis with Nasal Polyposis (CRSwNP) involves chronic inflammation and tissue remodeling.
- Histological analysis, the current standard for studying polyp remodeling, is invasive and limited to tissue fragments.
- Non-invasive imaging techniques are needed to characterize CRSwNP remodeling.
Purpose of the Study:
- To evaluate the efficacy of Magnetic Resonance Imaging (MRI) in depicting and characterizing the tissue remodeling process in CRSwNP patients.
- To correlate MRI findings with histological analysis and inflammatory markers.
Main Methods:
- 30 CRSwNP patients underwent conventional, diffusion-weighted, and DCE MRI.
- MRI findings were compared with polyp histology, IL-6 levels, and blood eosinophil counts.
- Two radiologists and a pathologist independently evaluated the imaging and tissue samples.
Main Results:
- A distinct pattern was observed: peripheral polyp tissue was edematous, while central portions were fibrotic.
- Apparent diffusion coefficient (ADC) values in anterior polyp portions may serve as radiological markers for phenotyping remodeling.
- High agreement was found between radiologists and histological analysis for edema and fibrosis.
- No correlation was found between eosinophilic inflammation, IL-6 levels, and the observed remodeling patterns.
Conclusions:
- MRI, particularly T2-weighted imaging and ADC values, effectively characterizes CRSwNP tissues.
- This non-invasive approach can differentiate between edematous and fibrotic components, aiding in understanding the remodeling process.
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