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Reprinted by permission of Int Forum Allergy Rhinol. 2015; 5(7):637-642.

OR I G I NAL ART I CLE

Computer-assisted staging of chronic rhinosinusitis correlates with symptoms Jonathan Garneau, MD 1 , Michael Ramirez, BS 1 , Samuel G. Armato III, PhD 2 , William F. Sensakovic, PhD 3 , Megan K. Ford, MD 2 , Colin S. Poon, MD, PhD, FRCPC 2 , Daniel T. Ginat, MD 2 , Adam Starkey, BS 2 , Fuad M. Baroody, MD 4 and Jayant M. Pinto, MD 4

Background: The Lund-Mackay (LM) staging system for chronic rhinosinusitis (CRS) does not correlate with clin- ical parameters, likely due to its coarse scale. We devel- oped a “Modified Lund Mackay” (MLM) system, which uses a three-dimensional (3D), computerized method to quan- tify the volume of mucosal inflammation in the sinuses, and sought to determine whether the MLM would correlate with symptoms and disease-specific quality of life. Methods: We obtained Total Nasal Symptom Score (TNSS) and 22-item Sino-Nasal Outcome Test (SNOT-22) data from 55 adult subjects immediately prior to sinus imaging. The volume of each sinus occupied by mucosal inflammation was measured using MATLAB algorithms created using cus- tomized, image analysis so ware a er manual outlining of each sinus. Linear regression was used to model the rela- tionship between the MLM and the SNOT-22 and TNSS. Correlation between the LM and MLM was tested using Spearman’s rank correlation coefficient. C hronic rhinosinusitis (CRS) is a highly prevalent dis- ease posing a substantial economic burden on the 1 Pritzker School of Medicine, The University of Chicago, Chicago, IL; 2 Department of Radiology, The University of Chicago, Chicago, IL; 3 Department of Radiology, Florida Hospital, Orlando, FL; 4 Section of Otolaryngology–Head and Neck Surgery, Department of Surgery, The University of Chicago, Chicago, IL Correspondence to: Jayant M. Pinto, MD, The University of Chicago, 5841 S. Maryland Ave., MC 1035, Chicago, IL 60637; e-mail: jpinto@surgery.bsd.uchicago.edu Current affiliation of Jonathan Garneau: Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY. Current affiliation of Megan K. Ford: Department of Internal Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA. Current affiliation of Colin S. Poon: Department of Radiology, Orillia Soldiers’ Memorial Hospital, Orillia, ON, Canada. Jonathan Garneau and Michael Ramirez contributed equally to this work. Funding sources for the study: M.R. and J.G. were supported by the Pritzker School of Medicine; J.G. received funding from the Icahn School of Medicine; J.M.P. received funding from the National Institute on Aging and Results: Adjusting for age, gender, and smoking, a higher symptom burden was associated with increased sinonasal

inflammation as captured by the MLM ( β = 0.453, p < 0.013). As expected due to the differences in scales, the LM and MLM scores were significantly different ( p < 0.011). No association between MLM and SNOT-22 scores was found. Conclusion: The MLM is one of the first imaging-based scoring systems that correlates with sinonasal symptoms. Further development of this custom so ware, including full automation and validation in larger samples, may yield a biomarker with great utility for both treatment of patients and outcomes assessment in clinical trials. C 2015 ARS- AAOA, LLC. Key Words: sinusitis; chronic sinusitis symptoms; computed tomogra- phy; computer-assisted image analysis; quality of life; Lund- Mackay; sinonasal How to Cite this Article: Garneau J, Ramirez M, Armato SG III, et al. Computer- assisted staging of chronic rhinosinusitis correlates with symptoms. Int Forum Allergy Rhinol . 2015;5:637–642. healthcare system. 1 Although significant effort has been devoted to investigating its pathophysiologic basis, efficacy of various therapies, and utility of diagnostic tools such as imaging and endoscopy, our understanding of these areas remains limited. A major barrier to progress in developing the National Institute of Allergy and Infectious Disease (AG036762; AI106683); the study was also supported in part by a Preclinical Pilot Translational Study Award from The University of Chicago Institute for Translational Medicine (UL1TR000430). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Potential conflict of interest: S.G.A. receives royalties and licensing fees for computer-aided diagnosis technology through the University of Chicago. All other authors declare no conflicts of interest. Presented orally at the Annual ARS Meeting at the American Academy of Otolaryngic Allergy Annual Meeting on September 20, 2014, Orlando, FL. Received: 19 September 2014; Revised: 28 November 2014; Accepted: 1 January 2015 DOI: 10.1002/alr.21499 View this article online at wileyonlinelibrary.com.

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