Role of Multi-Detector CT in Paranasal Sinuses Essay.

Role of Multi-Detector CT in Paranasal Sinuses Essay.

Introduction: This statement describes the purpose, procedures, benefits, risks and discomforts of the study and your right to withdraw from the study at any point of time.,Purpose: This study involves MDCT scan evaluation of patients with paranasal sinus complaints.Role of Multi-Detector CT in Paranasal Sinuses Essay.,Study Procedure: Your relevant clinical history will be recorded, clinical examination will be conducted and findings noted. MDCT PNS will be performed and the radiological findings will be recorded. These findings are correlated with clinical/surgical/histopathological/microbiological findings.,Benefits: No monetary benefits will be given to you. However, any new information that can come to light regarding any new findings in the study will help in further management of the disease and help all other ailing patients suffering from this problem.,Confidentiality: Records of your study participation will be kept confidential, under safe custody. Any publication of data will not identify you by name. By signing the consent form you authorise the sharing of your study related medical records to the regulatory authorities and the Institutional Ethical Committee.,Information regarding withdrawal: You have the right to withdraw yourself from the study at any time during the course of the study without any prejudice to you or your family’s right to undergo future treatment at BATRA HOSPITAL.,Contact for additional information: Any time during or after the study, you can obtain further information about the study from Dr. Lakshmi Kumar Chalamarla, Department of Radio-diagnosis, BHMRC, New Delhi.,ORDER A PLAGIARISM-FREE PAPER HERE,DATA ANALYSIS,Sensitivity, specificity, positive predictive value and negative predictive values were calculated, followed by use of Fischer Exact test. Diagnostic accuracy of MDCT for different pathologies were calculated,The research hypothesis and statistical methods were formed in consultation with the Biostatistician.Role of Multi-Detector CT in Paranasal Sinuses Essay.,SALIENT FINDINGS,Key imaging features considered were significant anatomical variations, site of involvement, bony and soft tissue changes, invasion of surrounding structures, pathognomic features and correlation with clinical complaints/surgical/pathological/microbiological findings.,The patients were divided into five categories: bacterial sinusitis, fungal sinusitis, benign tumors, malignant tumors, and others. 84 patients presented with sub acute or chronic bacterial sinusitis, 4 patients were of fungal sinusitis, 4 patients presented with benign tumors, 3 patients with malignant tumors and 5 patients with other conditions.,Among 84 patients with bacterial sinusitis, 26 patients presented with sporadic pattern, 23 patients with infundibular pattern, 23 patients with ostiomeatal unit pattern, 8 patients with polyposis pattern, and 4 patients with sphenoid recess pattern.,The various causative factors which came across in infundibular pattern were Haller cells in 6 cases, giant bulla ethmoidalis in 6 cases, uncinate process pneumatisation in 1 case, and mucoperiosteal thickening in 10 cases.,The various causative factors for ostiomeatal pattern which were found during our study were: inferior turbinate hypertrophy in 6 cases, giant bulla ethmoidalis in 6 cases, deviated nasal septum with or without septal spur in 4 cases, concha bullosa in 3 cases, concha lamella in 2 cases, agger nasi cell in 1 case, and paradoxical middle turbinate in 1 case.,The various findings which were encountered in bacterial sinusitis in our study were: mucoperiosteal thickening in 84 cases, ostiomeatal unit block in 31 patients, bone thickening in 20 patients, bone thinning in 8 cases, and bone sclerosis in 6 patients.,Various anatomical variations were encountered during our study. One or the other anatomic variation was found in 99 cases ( 99% ).,Of the structures around ostiomeatal unit, giant bulla ethmoidalis was found in 35 cases, middle turbinate pneumatisation in 33 cases, paradoxical curvature of middle turbinate in 19 cases. Haller cell was found in 15 cases. Type 1 frontal sinus drainage pathway in 78 cases, type 2 frontal sinus drainage pathway in 21 cases. Deviated nasal septum with or without septal spur in 55 cases, inferior turbinate hypertrophy in 30 cases, accessory maxillary ostia in 26 cases, and agger nasi cell in 93 cases. Type 1 optic nerve course was found in 53 cases, type 2 in 14 cases, type 3 in 9 cases, and type 4 optic nerve course along with Onodi cells in 23 cases. Type 1 anterior clinoid process pneumatisation was found in 10 cases, type 2 pneumatisation in 1 case. Sphenoid septum lateral attachment in 7 cases, and sphenoid sinus septum pneumatisation in 14 cases.Role of Multi-Detector CT in Paranasal Sinuses Essay.,Among 4 patients with fungal sinusitis, the various findings were: bilateral / multisinus involvement was found in 4 cases, expansion of any involved sinus was found in 4 cases, intrasinus hyperdensity was found in 4 cases. Bony thinning was found in 4 cases, bony erosions and nasal cavity involvement was found in 3 cases.,The various findings in 4 cases of benign tumors seen ( 1 inverted papilloma, 1 juvenile angiofibroma and 2 ivory osteomas ) were: bony thinning in 2 cases, bony remodelling in 2 cases, multisinus involvement in 2 cases, intracranial extension in 1 case, and intra orbital extension in 1 case. Bony destruction, bone thickening/sclerosis, and calcification were not seen in any of the cases.,Among 3 cases of malignant tumors, various findings were: : Bony destruction in 3 cases, bony thinning in 3 cases, bony remodelling in 0 cases, multisinus involvement in 2 cases, intracranial extension in 2 cases, and intra orbital extension in 3 cases. Bone thickening/sclerosis, and calcification were not seen in any of the cases.,In our study we found sensitivity and specificity for bacterial sinusitis as 100% and 94.11% respectively. The fungal sinusitis had sensitivity an specificity of 75% and 100% respectively. Benign, malignant tumors and others had sensitivity and specificity of 100%. The diagnostic accuracy for bacterial sinusitis and fungal sinusitis was 99%, and the diagnostic accuracy of benign, malignant tumors and others was 100%. The p value was obtained after applying Fischer Exact test. The p value obtained was statistically significant for all the disease conditions.,Based on the statistical values it can be inferred that multi detector computed tomography is useful to characterize paranasal sinuses lesions with respect to anatomical delineation, extension and bony involvement.,There are certain limitations in our study. Our findings cannot be generalised to the whole population because of the limited sample size. However, our findings add value to the research done. The role of contrast cannot be adequately studied. The role of MRI in various paranasal sinus pathologies was not evaluated.,CONCLUSIONS,Paranasal sinus diseases are very commonly encountered problems in clinical practice. Clinical assessment alone is not sufficient to reach a diagnosis, as the presentation of most of the conditions is nonspecific.Role of Multi-Detector CT in Paranasal Sinuses Essay. Imaging forms the mainstay not only in making correct diagnosis, but also to know the extent of lesion, pre-operative assessment of the sinonasal anatomy and commonly encountered anatomic variations. X ray has low sensitivity, specificity, positive and negative predictive values. CT is highly sensitive and specific in determining the presence of paranasal sinus pathology and clearly demonstrates the complex anatomy. The introduction of multi detector CT has transformed the axial imaging modality into a volumetric one and allows the pathology to be displayed in any desired plane. The capability of thin-section acquisition improves visualisation of tiny pathological details, and the isotropic nature of high spatial resolution data sets enables display in multiple planes, obviating image acquisition in prone or hyper extended patient position.,RECOMMENDATIONS

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