Abstract
The aim of the study was to compare visualisation of the surgically relevant anatomical structures via low- and standard-dose multidetector CT protocol in patients with chronic rhinosinusitis (CRS) and higher risk for perioperative complications (i.e. presence of bronchial asthma, history of sinus surgery and advanced nasal polyposis). 135 adult CRS patients were divided randomly into standard-dose (120 kVp, 100 mAs) or low-dose CT groups (120 kVp, 45 mAs). The detectability of the vital anatomical structures (anterior ethmoid artery, optic nerve, cribriform plate and lamina papyracea) was scored using a five-point scale (from excellent to unacceptable) by a radiologist and sinus surgeon. Polyp sizes were quantified endoscopically according to the Lildholdt’s scale (LS). Olfactory function was tested with the “Sniffin’ Sticks” test. On the low-dose CT images, detectability ranged from 2.42 (better than poor) for cribriform plate among anosmic cases to 4.11 (better than good) for lamina papyracea in cases without nasal polyps. Identification of lamina papyracea on low-dose scans was significantly worse in each group and the same was the case with cribriform plates in patients with advanced polyposis and anosmia. Cribriform plates were the most poorly identified (between poor and average) among all the structures on low-dose images. Identification of anterior ethmoid artery (AEA) with reduced dose was insignificantly worse than with standard-dose examination. The AEA was scored as an average-defined structure and was the second weakest visualised. In conclusion, preoperatively, low-dose protocols may not sufficiently visualise the surgically relevant anatomical structures in patients with CRS and bronchial asthma, advanced nasal polyps (LS > 2) and history of sinus surgery. Low mAs value enables comparable detectability of sinonasal landmarks with standard-dose protocols in patients without analysed risk factors. In the context of planned surgery, the current preferences of the tube should be carefully evaluated for different patient constitutions to minimise the risk of complications.
Highlights
Endoscopic sinus surgery (ESS) is considered to be an effective treatment modality of choice for patients suffering from chronic rhinosinusitis (CRS) who fail medical therapy
Reducing the radiation dose is accompanied by compromised computed tomography (CT) image quality, low-dose scanning has come to be increasingly applied for preoperative planning
There were no significant differences between the two groups in terms of patient age, gender distribution, advancement of inflammation in sinuses on CT scans (L–M scale) and endoscopic score according to Lildholdt’s scale (LS)
Summary
Endoscopic sinus surgery (ESS) is considered to be an effective treatment modality of choice for patients suffering from chronic rhinosinusitis (CRS) who fail medical therapy. Adequate preoperative patient evaluation involves computed tomography (CT) examination, which is paramount in preventing complications in ESS [1]. The growing prevalence of patients complaining of sinus-like symptoms requiring diagnostic imaging has increased the awareness of potential hazards from radiation exposure. Reducing the radiation dose is accompanied by compromised CT image quality, low-dose scanning has come to be increasingly applied for preoperative planning.
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