Plain radiography versus computed tomography scan in evaluation of adults with chronic rhinosinusitis in Zaria, Nigeria

Abstract

Background: Chronic rhinosinusitis (CRS) can be a debilitating illness with major socioeconomic costs and decreased workplace productivity. Till date, paranasal sinus (PNS) radiography continues to be the primary imaging modality for diagnosing CRS in most developing countries. Computed tomography (CT) scan – the gold standard imaging modality is either unavailable or unaffordable in these regions. Aim: The aim of this study is to compare plain radiographic and CT scan findings of the PNSs in adults with CRS. Subjects and Methods: After initial clinical evaluation and rhinoscopy, consenting patients were assessed using both plain radiography (PR) and direct coronal CT scan of the PNSs. Results: One hundred and eighteen (68 males and 50 females) adults with a mean age of 39.4 years were involved in this study. The percentage agreement between PR and CT for sinus abnormalities was <80%. Using CT scan as the gold standard, PR had the highest diagnostic value in the maxillary sinus with sensitivity and specificity of 76.4% and 89.7%, respectively. Sensitivities and specificities for the ethmoid (50.0% and 76.2%), frontal (35.3% and 89.3%), and sphenoid sinuses (17.1% and 96.1%), respectively, were also recorded. Conclusion: In the diagnosis of chronic maxillary rhinosinusitis, correlation between PR and CT scan was good with high agreement. However, for chronic ethmoidal, frontal, and sphenoidal sinusitis, PR demonstrated poor agreement and weak correlations with CT scan. It is recommended that noncontrast coronal CT scan should replace paranasal PR as the initial imaging modality for evaluating adults with CRS where facilities are available.