LIMITED CT SCAN OF CORONAL SLICE WITH ROI
COMPARED TO THE OPERATION IN CHRONIC RINOSINUSITIS
Tolkha A, Tedjo O, Kartono S, Arin DI, Hamsu K, Asmoro Y. A Christanto
ENT Department, Medical Faculty of Gadjah Mada University-Dr. Sardjito
Hospital, Yogyakarta
ABSTRACT
Background: Rhinosinusitis is defined as the inflammation of nasal mucosa and
paranasal sinus mucosa, the chronic condition happened at least more than 12
weeks. CT scan in chronic rhinosinusitis was badly needed mainly for patient
having conservative treatment failure. CT scan of coronal slice of 2-3 mm
thickness becoming the main standard in the establishment of rhinosinusitis,
had the main obstacle of funding. Limited CT scan of coronal slice became an
alternative. CT scan could describe the osteomeatal complex condition, anatomy
defect, and visualization of the existence or non existence of pathology in
sinus. CT scan could be completed with region of interest (ROI). ROI could be a
kind of pathology in paranasal sinus and nasal cavity becoming a liquid or
tissue or bone based on its density.
Objective: To determine the sensitivity and specificity for limited CT scan of
coronal slice with ROI as the supporting diagnosis and the treatment in chronic
rhinosinusitis.
Method: This study was a diagnostic test to determine the validity of CT scan 4
slices with ROI compared to the operation in chronic rhinosinusitis. The
population of the study was all patient diagnosed chronic rhinosinusitis
underwent operation in Dr. Sardjito hospital, Prof. Dr. Oepomo ENT hospital,
and Bethesda Hospital Yogyakarta in the period of October 2004 April 2005.
The criteria of inclusion comprised of chronic rhinosinusitis patients
underwent operation and having limited CT scan of coronal slice (4 slices). The
statistical analysis using square Chi testing was used to calculate the level
of meaningfulness of fit difference between the ROI meaning and the operation
finding result. The average difference of each score of the phenomena was
determined using t-test. The relation between clinical symptom degree and CT
scan degree was assessed using linier regression test. Diagnostic test for ROI
in determining the tissue or liquid was using the formula based on sensitivity
and specificity.
Result: 22 patient chronic rinosinusitis underwent operation. The distribution
of the patients was found 14 men and 8 women, the younger age was 13 years old
and the oldest age was 48 year in average of 31 years. Chronic rinosinusitis
complain obtained had the following sequence: 1) obstructed nose (22[100%]
patients; in average 2.41), 2)discharge purulence (2 [95,5%]; 1.73), 3) sinus
pain (20 [91%]; 1.86), 4)head pain (20 [91%]; 1.78), 5)fatigue (14 [63.6%],
1.09), 6) smells disorder (13 [59.1%]; 1), and 7) sleep disorder (12 [54,5];
0.82). Sinus distribution involved was obtained maxillary sinus (81.8%),
anterior ethmoid sinus (78.5%), posterior ethmoid sinus (75%), sphenoid sinus
(34.1%), and frontal sinus (31.8%) with the value of 0.0001. Anatomy defect
appropriate with CT scan were concha bullosa 7 (31.8%), concha paradoxical 6
(27.3%), processus uncinatus elevation 4 (18.2%), haller cell 1 (4.5%), and
septum deviation 10 (45.5%). Thus ROI had overall fit of 77.8% compared to
the operation result. Sensitivity and specificity of ROI to assess the
existence of tissue was of 75% and 80% and ROI to assess the existence of
liquid had sensitivity and specificity of 80% and 75%, respectively. Narrowing
or obstructed osteometal complex condition was obtained sensitivity and
specificity of 87% and 60%, respectively.
Conclusion: Limited CT scan of coronal slice with ROI could be used to evaluate
the treatment and the operation preparation in chronic patient having
conservative treatment failure or had been found complication.
Keywords: Limited CT scan coronal, ROI, chronic rhinosinusitis
dr. HM Anton Christanto
Bag/SMF THT RSUP Dr Sardjito-FK UGM
Jl. Kesehatan no 1 Yogyakarta - Indonesia 55284
Phone/Fax : +62 274 7474230
Mobile +62(0)8122658495
Email : [EMAIL PROTECTED]
[EMAIL PROTECTED]
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