Endotype-Guided Imaging in Chronic Rhinosinusitis: HRCT/CBCT and MRI Metrics, Structured Reporting, and Radiomics-A...

Area of Science:

• Medical Imaging
• Otorhinolaryngology
• Inflammatory Diseases

Background:

• Chronic rhinosinusitis (CRS) is a complex inflammatory sinus disease.
• Accurate diagnosis and management require detailed patient assessment.
• Imaging modalities like HRCT, CBCT, and MRI are crucial for evaluating CRS.

Purpose of the Study:

• To systematically review evidence on endotype-aware imaging in CRS.
• To propose a structured reporting model for quantitative CRS management.
• To assess the role of radiomics and AI in CRS diagnosis and subtyping.

Main Methods:

• Systematic review following PRISMA 2020 guidelines.
• Searched multiple databases (MEDLINE, Scopus, Embase, Cochrane) from 2000-2025.
• Included 96 studies for qualitative synthesis and 38 for quantitative outcomes, evaluating imaging protocols, indices, and AI applications.

Main Results:

• HRCT is the primary modality for anatomy and planning; CBCT for bone evaluation; MRI for soft tissue and complications.
• Radiomics/AI achieved AUCs of 0.79-0.93 in distinguishing CRS endotypes, with limited external validation.
• Quantitative imaging criteria can enhance CRS management when combined with clinical data.

Conclusions:

• Endotype-aware imaging supports precise, quantitative CRS management.
• Structured reporting and radiomics offer potential for standardization.
• Prospective validation and transparent reporting are essential for clinical translation.