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Predictive Value of Computed Tomographic Ethmoid-to-Maxillary Ratio in Patients with Chronic Rhinosinusitis and Nasal
Pei-Wen Wu1,2, Zih-Hao Wei2, Chi-Che Huang1,2
1Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.
Objective:
Different types of inflammation in the sinuses require different treatments. Ethmoid dominance was proposed as an indicator on computed tomography (CT) images for type 2 chronic rhinosinusitis with nasal polyp (CRSwNP). This study evaluated the predictive value of the ethmoid-to-maxillary (E/M) ratio based on different CT scoring systems in type 2 CRSwNP.
Methods:
Adult patients with bilateral CRSwNP planning to undergo sinus surgery were prospectively recruited. CT images were evaluated using the Lund-Mackay (L-M) and Zinreich scoring systems which involved a more meticulous quantification of opacification on CT images. Tissue eosinophil count (TEC) was determined by histopathological analysis. The expression levels of type 2 cytokines in nasal polyps, including IL-5, IL-13, and eosinophil cationic protein (ECP), were measured using real-time PCR.
Results:
A total of 174 participants were enrolled. Eighty of these participants exhibited an E/M ratio >1, 49 presented with E/M ratio=1, and 45 showed an E/M ratio <1 based on L-M CT scores. Twenty of the 49 (40.8%) patients with E/M ratio=1 on L-M score turned to E/M ratio >1 after re-evaluation by Zinreich scoring system. The E/M ratio based on the L-M and Zinreich scoring systems both exhibited correlation with the tissue markers of type 2 inflammation, including TEC, interleukin (IL)-5, IL-13, and ECP expression levels, although the Zinreich E/M ratio showed a higher correlation coefficient.
Conclusion:
The E/M ratio based on the L-M and Zinreich scoring systems correlated with tissue markers of type 2 inflammation. A scale with an E/M ratio of 1 in the L-M system should be further investigated using a more detailed scoring system to determine the presence of an ethmoid-dominant shadow. This could help clinicians better evaluate CT images to determine the severity of type 2 inflammation in patients with CRSwNP and provide optimal therapeutic strategies.
