To Investigate The Features Of CT Images Of Eosinophilic Chronic Rhinosinusitis

Objective:To search clinical parameters of pre-diagnosis of eosinophilic chronic rhinosinusitis(ECRS)and investigate the characteristics of CT images of eosinophilic chronic rhinosinusitis.To attempt to diagnose chronic rhinosinusitis through sinus CT internal classification and improve the prospectiveness,accuracy and scientificity of diagnosis of ECRS.Method: Respective review were performed in 125 chronic rhinosinusitis patients who received operation in our department June 2016 to June 2017(74 cases with eosinophilic chronic rhinosinusitis(ECRS)and 51 cases with Noneosinophilic chronic rhinosinusitis(NonECRS).The data included clinical features of age,gender,duration,symptoms and other preoperative blood routine collection of peripheral blood eosinophils Absolute value,Peripheral Blood Eosinophil Percentage,Lund-Mackay score and GOSS(Global Osteitis Scoring Scale)osteitis score for the patient's preoperative sinus CT.The levels of eosinophils infiltration in the postoperative pathological tissue(percentage of eosinophils per inflammatory cell in the high-power field after surgery)were recorded.The ?2 test was used to compare the differences of gender,main symptoms(nasal obstruction,headache,pus snot,nasal itching,sneeze,hyposmia),unilateral or bilateral morbidity,and nasal polyps between the two groups.Mamn-Whitney U analysis was used to compare the differences of Lund-Mackay scores,GOSS scores,age,duration of disease,peripheral eosinophil absolutes,and percentage of eosinophils in the peripheral blood between the two groups.Calculation of the sensitivities the statistically significant clinical parameters between the two groups was perfomed.Binary logistic regression analysis was performed on clinical parameters with a sensitivity greater than or equal to 65% to search pre-diagnosis ECRS indicators.Receiver operating characteristic curve(ROC curve)was conducted to analyze the relationship between cutoff value and sensitivity and specificity,find the best cutoff value,and calculate the positive predictive value and negative predictive value of clinical parameters.The relationships between eosinophil infiltration and GOSS scores and Lund-Mackay scores;correlation analysis of GOSS-E(sum of bilateral ethmoid osteitis scores)and the course and age of ECRS were analyzed;The relationship between ECRS paranasal sinus CT features and the course of disease,age,eosinophil infiltration were investigated.Result: Clinical parameters such as GOSS osteitis total score,GOSS-E(sum of bilateral ethmoid osteitis scores),Lund-Mackay total score,E(Lund-Mackay bilateral ethmoid sinus total score),peripheral blood eosinophil absolute Value,percentage of peripheral blood eosinophils,E/M(ratio of Lund-Mackay total bilateral ethmoid sinus to total bilateral maxillary sinus),and PE/AE(ratio of Lund-Mackay total bilateral posterior ethmoid sinus score to total bilateral anterior ethmoid sinus),in ECRS group were significantly higher than NonECRS group [17.0(7.0;24.0)vs 9.0(5.0;15.2),7.0(3.0;10.0)vs 3.0(1.0;6.0),20.0(16.0;26.0)to 13.0(10.0;19.0),7.0(4.0;8.0)to 3.0(2.0;5.2),3.0(1.0;5.0)to 1.0(1.0;2.0),2.9(1.0;7.2)% to 1.1(0.6;2.0)%,2.0(2.0;2.6)to 1.0(1.0;1.5),1.0(0.5;1.0)to 0.5(0.0;0.8);U values were 1234.0,1134.5,854.0,609.0,1003.0,1073.5,227.5,1046.5,respectively,P were ? 0.05];Patients of ECRS group have higher incidence of bilateral disease,nasal polyps,nasal itching and sneeze than those of NonECRS group,and pus snot were rarer in ECRS group.[? 2 were 14.14,3.88,9.14,7.17,6.85,respectively.P ?0.05].The index of nasal polyps,unilateral or bilateral onset,E/M,Lund-Mackay total score,E,PE/AE,absolute peripheral blood eosinophils,percentage of eosinophils in peripheral blood,The sensitivity of GOSS-E,GOSS osteitis total score,nasal itching,and sneeze pre-diagnosis ECRS were 96%,92%,92%,77%,75%,70%,67%,65%,61%,60%,12%,14%,respectively.Binary logistic regression analysis showed that E/M and peripheral blood eosinophil ratio were statistically significant in pre-diagnosis of ECRS(p ? 0.05),The ROC curve analysis showed that joint factors was the best,and the area under the curve(AUC)was 0.95.The E/M of the CT scan was clinically paractical to diagnosis ECRS(AUC=0.94),whose best cutoff value was 1.87,sensitivity was 92%,specificity was 89%,and positive predictive value was 85%,negative predictive valuer was 94%,espectively.The peripheral blood eosinophils percentage in ECRS group had a cutoff of 2.25%(AUC=0.71),a sensitivity of 65%,a specificity of 80%,and a positive predictive value of 70%,and a negative predictive value of 77%.In addition,the Lund-Mackay scores,the E,and the GOSS-E were positively related to the number of eosinophil infiltration in pathological tissue(r=0.50,0.62,0.41,p<0.05),and the GOSS-E was positively related to the course of ECRS(r = 0.35,p = 0.005)and unrelated to the age.Conclusion: The Sinus CT Lund-Mackay Score E/M and peripheral blood eosinophil percentages can be used as clinical parameters to diagnosing ECRS.The GOSS osteitis score,and the Lund-Mackay score positively correlate to the severity of ECRS;the GOSS-E positively correlate to the course of ECRS and incorrelate to the age.