tailieunhanh - Evidence-Based Imaging - part 5

Một nghiên cứu khác bởi Lee et al. (43) cũng đã xác nhận hiệu suất tốt hơn chẩn đoán của xoang CT so với các bộ phim đồng bằng trong 33 bệnh nhi bị viêm xoang mãn tính. Trong báo cáo đó, độ nhạy và độ đặc hiệu của bộ phim xoang đồng bằng là 74% và 76% đối với bệnh xoang hàm trên và 41% và 44% đối với bệnh xoang hai xoang sàng, tương ứng. | 224 Y. Anzai and . Neighbor Jr. 42 . Another study by Lee et al. 43 also confirmed better diagnostic performance of sinus CT compared with plain films in 33 pediatric patients with chronic sinusitis. In that report sensitivity and specificity of sinus plain films were 74 and 76 for maxillary sinus disease and 41 and 44 for ethmoid sinus disease respectively. There is conflicting evidence whether CT scan correlates with patients clinical symptoms 44-46 . Patients with severe clinical symptoms may not have substantial mucosal thickening on CT. Arango and Kountakis 47 reported on the other hand that higher clinical symptom scores were seen in patients with severe abnormality on CT compared with patients with normal or minimum findings on CT and that the differences between these two groups were statistically significant. The fact that patient symptom scores did not correlate with the extent of the disease on CT may not necessarily indicate poor accuracy of sinus CT. When sinus CT is normal for a patient with a clinical diagnosis of chronic sinusitis it is uncertain whether sinus CT underestimates disease or the patient warrants other diagnoses. C. Imaging Findings of Chronic Sinusitis Sinus CT may show mucosal thickening in various degrees from minimal mucosal thickening to severe opacification of the paranasal sinuses. Frequently for various reasons sinus CT shows no or only minimal mucosal abnormality. Those patients with persistent chronic sinusitis symptoms have taken antiinflammatory medication as well as nasal spray thus the degree of mucosal inflammation is usually subtle. Some ear nose and throat ENT surgeons schedule CT scan 4 to 6 weeks after antibiotic treatment in order to see fine bone detail which is often obscured by mucosal disease. Alternatively those patients may have some other disease mimicking chronic sinusitis. At the other extreme sinus CT may show severe opacification of all paranasal sinuses. Occasionally bone thickening or sclerosis of the