J H Harreld1, R A Kaufman2, G Kang3, G Maron4, W Mitchell5, J W Thompson6,7, A Srinivasan5. 1. From the Departments of Diagnostic Imaging (J.H.H., R.A.K.), Julie.harreld@stjude.org. 2. From the Departments of Diagnostic Imaging (J.H.H., R.A.K.). 3. Biostatistics (G.K.). 4. Infectious Diseases (G.M.). 5. Bone Marrow Transplantation and Cellular Therapy (W.M., A.S.), and. 6. Surgery (J.W.T.), St. Jude Children's Research Hospital, Memphis, Tennessee. 7. Department of Otolaryngology (J.W.T.), University of Tennessee Health Sciences Center, Memphis, Tennessee.
Abstract
BACKGROUND AND PURPOSE: The clinical benefit of pre-hematopoietic cell transplantation sinus CT screening remains uncertain, while the risks of CT radiation and anesthesia are increasingly evident. We sought to re-assess the impact of screening sinus CT on pretransplantation patient management and prediction of posttransplantation invasive fungal rhinosinusitis. MATERIALS AND METHODS: Pretransplantation noncontrast screening sinus CTs for 100 consecutive patients (mean age, 11.9 ± 5.5 years) were graded for mucosal thickening (Lund-Mackay score) and for signs of noninvasive or invasive fungal rhinosinusitis (sinus calcification, hyperattenuation, bone destruction, extrasinus inflammation, and nasal mucosal ulceration). Posttransplantation sinus CTs performed for sinus-related symptoms were similarly graded. Associations of Lund-Mackay scores, clinical assessments, changes in pretransplantation clinical management (additional antibiotic or fungal therapy, sinonasal surgery, delayed transplantation), and subsequent development of sinus-related symptoms or invasive fungal rhinosinusitis were tested (exact Wilcoxon rank sums, Fisher exact test, significance P < .05). RESULTS: Mean pretransplantation screening Lund-Mackay scores (n = 100) were greater in patients with clinical symptoms (8.07 ± 6.00 versus 2.48 ± 3.51, P < .001) but were not associated with pretransplantation management changes and did not predict posttransplantation sinus symptoms (n = 21, P = .47) or invasive fungal rhinosinusitis symptoms (n = 2, P = .59). CONCLUSIONS: Pre-hematopoietic cell transplantation sinus CT does not meaningfully contribute to pretransplantation patient management or prediction of posttransplantation sinus disease, including invasive fungal rhinosinusitis, in children. The risks associated with CT radiation and possible anesthesia are not warranted in this setting.
BACKGROUND AND PURPOSE: The clinical benefit of pre-hematopoietic cell transplantation sinus CT screening remains uncertain, while the risks of CT radiation and anesthesia are increasingly evident. We sought to re-assess the impact of screening sinus CT on pretransplantation patient management and prediction of posttransplantation invasive fungal rhinosinusitis. MATERIALS AND METHODS: Pretransplantation noncontrast screening sinus CTs for 100 consecutive patients (mean age, 11.9 ± 5.5 years) were graded for mucosal thickening (Lund-Mackay score) and for signs of noninvasive or invasive fungal rhinosinusitis (sinus calcification, hyperattenuation, bone destruction, extrasinus inflammation, and nasal mucosal ulceration). Posttransplantation sinus CTs performed for sinus-related symptoms were similarly graded. Associations of Lund-Mackay scores, clinical assessments, changes in pretransplantation clinical management (additional antibiotic or fungal therapy, sinonasal surgery, delayed transplantation), and subsequent development of sinus-related symptoms or invasive fungal rhinosinusitis were tested (exact Wilcoxon rank sums, Fisher exact test, significance P < .05). RESULTS: Mean pretransplantation screening Lund-Mackay scores (n = 100) were greater in patients with clinical symptoms (8.07 ± 6.00 versus 2.48 ± 3.51, P < .001) but were not associated with pretransplantation management changes and did not predict posttransplantation sinus symptoms (n = 21, P = .47) or invasive fungal rhinosinusitis symptoms (n = 2, P = .59). CONCLUSIONS: Pre-hematopoietic cell transplantation sinus CT does not meaningfully contribute to pretransplantation patient management or prediction of posttransplantation sinus disease, including invasive fungal rhinosinusitis, in children. The risks associated with CT radiation and possible anesthesia are not warranted in this setting.
Authors: Claudia F E Kirsch; Julie Bykowski; Joseph M Aulino; Kevin L Berger; Asim F Choudhri; David B Conley; Michael D Luttrull; Diego Nunez; Lubdha M Shah; Aseem Sharma; Vilaas S Shetty; Rathan M Subramaniam; Sophia C Symko; Rebecca S Cornelius Journal: J Am Coll Radiol Date: 2017-11 Impact factor: 5.532
Authors: Young-Woong Won; Seong Yoon Yi; Jun Ho Jang; Kihyun Kim; Seok Jin Kim; Won Seog Kim; Chul Won Jung; Dong Hwan Kim Journal: Int J Hematol Date: 2011-03-01 Impact factor: 2.490
Authors: Ellen R Wald; Kimberly E Applegate; Clay Bordley; David H Darrow; Mary P Glode; S Michael Marcy; Carrie E Nelson; Richard M Rosenfeld; Nader Shaikh; Michael J Smith; Paul V Williams; Stuart T Weinberg Journal: Pediatrics Date: 2013-07 Impact factor: 7.124