Screening sinus CT scans in pediatric bone marrow transplant patients

Objective: To determine how sinus disease noted on pre-bone marrow transpla nt (BMT) screening sinus computed tomography (CT) scans relates to subseque nt development of clinical and/or radiographic sinusitis and correlates wit h overall prognosis. Methods: A retrospective review of medical records, CT scans, and BMT database statistics was performed on all pediatric BMT reci pients from January 1992 through December 1997. Fifty-four pre-BMT CT scans were performed on 51 children, aged from 2 months to 17 years. Sinus disea se was staged according to criteria established by Lund and Kennedy [V.J. L und, D.W. Kennedy, Ann. Otol. Rhinol. Laryngol. S167 (1995) 17-21.]. Result s: The average age of BMT recipients was 6.8 years. Most common oncologic d iagnoses included acute myelogenous leukemia (37%), acute lymphoblastic leu kemia (17%), and stage IV neuroblastoma (13%). Screening sinus CT scans wer e routinely performed 1-3 months prior to BMT. On pre-BMT CT scans 48% of t he patients had no evidence of sinus disease, 25.9% mild disease, 9.3% mode rate disease, and 16.7% severe disease. Two-thirds (66.7%) of patients with severe sinus disease on pre-BMT CT scans experienced clinical sinusitis po st-BMT. In contrast, sinus symptoms were much less common (21.4%) in those with mild disease on CT scan. Overall, 39.3% of patients with sinus abnorma lities on pre-BMT CT scans had clinical sinusitis during their post-BMT cou rse, compared to 23.1% of those with normal CT scans pre-BMT. In addition, those patients demonstrating sinus disease on their pre-BMT CT scan were mo re likely to have radiographic sinusitis post-BMT (25.0%) than those with n o disease (7.7%). Seventy-eight percent of those with severe sinusitis had died by 2-year follow up, compared to 69.2% of patients with normal CT scan s pre-BMT. Conclusions: Severity of radiographic sinus disease on pre-BMT C T scans was noted to correlate with clinical and radiographic sinusitis lat er in the post-BMT course, and was associated with a trend toward decreased survival. Pre-BMT CT scans may be useful in determining which children nee d early and more aggressive intervention for clinical sinusitis post-BMT. ( C) 2000 Elsevier Science Ireland Ltd. All rights reserved.