RADIOGRAPHIC IMAGING STUDIES IN PEDIATRIC CHRONIC SINUSITIS

Background: The diagnosis of chronic sinusitis is dependent an the rad iographic evidence of sinus disease. Methods: We evaluated the perform ance of radiographs and computed tomographic (CT) scans for the examin ation of the paranasal sinuses of 91 patients of both sexes, ranging i n age from 2 to 17 years, who had chronic upper respiratory tract symp toms for at least 3 months. The CT scan findings were categorized as n o disease; minimal disease, and mild, moderate, and severe sinusitis. Results: Fifty-eight patients (63%) had chronic sinusitis: CT scan abn ormalities were minimal in 17%, mild in 19%, moderate in 21%, and seve re in 43%. There was a statistically significant correlation between r hinorrhea (r = 0.25, p = 0.01), cough (r = 0.27, p = 0.009), and the s everity of sinus abnormality as determined by CT scan. Clinical presen tation in the mild, moderate, and severe sinusitis groups (p < 0.05) w as significantly different from that of the no disease group, whereas the minimal disease group had subclinical presentation (p = 0.11). Cli nically significant chronic sinusitis often occurred at multiple sites : 44% of patients had pansinusitis, 50% had disease involvement of at least two sinuses, and 6% had disease in a single sinus. When sinus ra diographs were compared with CT scans (n = 70 cases), radiographs coul d not identify minimal disease. For clinically significant sinusitis, sinus radiographs detected disease in 1 of 5 (20%) frontal sinuses, 0 of 12 (0%) sphenoidal sinuses, and 17 of 31 (54%) ethmoidal sinuses. W ith the minimal criteria of 40% to 50% opacification or fluid level fi lling of the maxillary antrum, radiographs detected disease in 37 of 4 9 (75%) cases. The sensitivity and specificity for a Waters view to co nfirm clinically significant chronic sinusitis without specifying the sites and severity were acceptable at 76% and 81%, respectively. When limited sinus CT scans were compared with full CT evaluation (n = 49 c ases), limited studies detected 5 of 5 (100%) frontal, 9 of 11 (82%) s phenoidal, 14 of 19 (73%) ethmoidal, and 39 of 40 (97%) cases of maxil lary sinusitis. The overall agreement was 88%. Conclusions: A single W aters view is art acceptable part of the initial evaluation of pediatr ic chronic sinusitis; however, a limited CT scan is a better alternati ve.