Diagnostic accuracy of contrast enhanced computed tomography in evaluation of paranasal sinus pathologies

Abstract

Background: The diseases of the Para Nasal Sinuses (PNS) cover a wide range of illnesses, from inflammatory conditions to benign and malignant neoplasms with wide range of symptoms from mild headaches to severe symptoms due to intracranial, intra temporal or intra orbital extensions. Contrast enhanced computed tomography (CECT) has been the imaging method of choice in the pre-operative examination of patients who are candidates for functional endoscopic sinus surgery (FESS), also known as Screening sinus CT(SSCT). Aim: This study aims to evaluate the Paranasal sinus (PNS) pathologies on Contrast Enhanced Computerised Tomography (CECT) and to correlate CECT findings with eventual histopathological findings to evaluate diagnostic accuracy of the modality. Materials and methods: This study included CECT evaluation of 50 patients with clinically suspected paranasal sinus pathologies and clearly demonstrated a very high diagnostic accuracy of CECT PNS for evaluation of various paranasal sinus pathologies. A structured pre-prepared case proforma will be used to enter the patient details, detailed clinical history related to paranasal sinus pathologies, physical examination of patients who meet the inclusion criteria. Results: In the present study, patient ranged between 9-67 years. Maximum number of cases 36% belongs to the age group 21-30 years followed by 31-40 years (20%).The maxillary sinus was the most commonly affected sinus in this study in 44 patients (88%), followed by the anterior ethmoid (78%), posterior ethmoid (66%), frontal sinus (52%) and least affected was sphenoid sinus (42%). Inflammatory polyp has a sensitivity of 100% and a specificity of 94.2% when comparing CECT diagnosis to histopathology. The sensitivity of benign lesions is 78.5% and the specificity is 100%. CECT has a lower sensitivity of 66.6% and a higher specificity of 100% for diagnosing fungal sinusitis with a diagnostic accuracy of 94%. CT offers 100% sensitivity for identifying malignant and non-specific inflammation. Conclusion: CECT is also imaging modality of choice for evaluation of anatomic variants present in nose and paranasal sinuses which must be known to a surgeon before surgery to avoid intra operative and post operative complications, Hence preoperative CECT serves as a ROAD MAP to functional endoscopic sinus surgery.