Diagnostic Accuracy of Computed Tomography in the Diagnosis of Fungal Sinusitis Keeping Histopathology as A Gold Standard

. Bushra; Nasreen  Aman

doi:10.54112/bcsrj.v6i6.2157

Authors

. Bushra Department of Diagnostic Radiology, Lady Reading Hospital, Peshawar, Pakistan
Nasreen Aman Department of Diagnostic Radiology, Lady Reading Hospital, Peshawar, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v6i6.2157

Keywords:

Computed Tomography, Fungal Sinusitis, Diagnostic Accuracy, Histopathology, Sensitivity, Specificity

Abstract

Fungal sinusitis is an increasingly recognized cause of chronic sinonasal disease, particularly in immunocompromised and diabetic patients. Early and accurate diagnosis is essential for appropriate surgical and medical management. Computed tomography (CT) of the paranasal sinuses is widely used for initial evaluation; however, its diagnostic performance must be validated against histopathology, which remains the gold standard. Objective: To determine the diagnostic accuracy of computed tomography (CT) in diagnosing fungal sinusitis, using histopathological findings as the gold standard. Methods: This cross-sectional validation study included 143 patients aged 18–65 years presenting with clinical suspicion of fungal sinusitis. Patients with sinonasal tumors, antrochoanal polyps, and pregnant or lactating women were excluded from the Radiology Department, Lady Reading Hospital, Peshawar. The study duration was from 25-10-2024 to 25-04-2025. All participants underwent CT scanning of the paranasal sinuses followed by surgical intervention and histopathological examination. Diagnostic accuracy parameters, including sensitivity, specificity, and overall accuracy, were calculated using a 2×2 contingency table. Data analysis was performed using SPSS version 25. Results: The mean age of the patients was 42.75 + 14.689 years, there were 93 (65%) male patients. CT scan showed fungal sinusitis positive in 88 patients (61.5%), while histopathology in 75 patients (52.4%). Diagnostic accuracy of CT scan for fungal sinusitis was 85.31%, with sensitivity 94.67% and specificity 75%, respectively. Conclusion: Computed tomography is an effective and reliable imaging modality for diagnosing fungal sinusitis, demonstrating high sensitivity and good diagnostic accuracy compared with histopathology. CT scanning is a valuable noninvasive diagnostic tool for early detection and preoperative assessment of fungal sinusitis.

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References

Goyal SS, Doering M, Kendall PL, Farrell N, Schneider JS, Roland LT. Progression of noninvasive fungal sinusitis to invasive fungal sinusitis: a systematic review. Int Forum Allergy Rhinol. 2023;13(6):1024-1033. https://doi.org/10.1002/alr.23097

Slonimsky G, McGinn JD, Goyal N, Crist H, Hennessy M, Gagnon E, et al. A model for classification of invasive fungal rhinosinusitis by computed tomography. Sci Rep. 2020;10(1):12591. https://doi.org/10.1038/s41598-020-69434-z

Nathan K, Majhi SK, Bhardwaj R, Gupta A, Ponnusamy S, Basu C, et al. The role of diagnostic nasal endoscopy and a computed tomography scan (nose and PNS) in the assessment of chronic rhinosinusitis: a comparative evaluation of the two techniques. Sinusitis. 2021;5(1):59-66. https://doi.org/10.3390/sinusitis5010007

Groppo ER, El-Sayed IH, Aiken AH, Glastonbury CM. Computed tomography and magnetic resonance imaging characteristics of acute invasive fungal sinusitis. Arch Otolaryngol Head Neck Surg. 2011;137(10):1005-1010. https://doi.org/10.1001/archoto.2011.170

Brooks L, Puccia R, Broglie L, Gorelik M, Park M, Chun RH. Utility of diagnostic sinus CT for diagnosis of invasive fungal sinusitis in immunocompromised children. Int J Pediatr Otorhinolaryngol. 2025;198:112593. https://doi.org/10.1016/j.ijporl.2025.112593

Ito K, Hara Y, Iizuka N, Sawada E, Suemitsu M, Kuyama K, et al. Differential diagnosis between fungal maxillary sinusitis and odontogenic sinusitis using CT images. Int J Oral Health Sci. 2019;17(3-4):100-107.

Roland LT, Humphreys IM, Le CH, Babik JM, Bailey CE, Ediriwickrema LS, et al. Diagnosis, prognosticators, and management of acute invasive fungal rhinosinusitis: multidisciplinary consensus statement and evidence-based review with recommendations. Int Forum Allergy Rhinol. 2023;13(9):1615-1714. https://doi.org/10.1002/alr.23132

Singh AK, Gupta P, Verma N, Khare V, Ahamad A, Verma V, et al. Fungal rhinosinusitis: microbiological and histopathological perspective. J Clin Diagn Res. 2017;11(7):DC10-DC14.

Khullar T, Kumar J, Sindhu D, Garg A, Meher R. CT imaging features in acute invasive fungal rhinosinusitis: recalling the oblivion in the COVID era. Curr Probl Diagn Radiol. 2022;51(5):798-805. https://doi.org/10.1067/j.cpradiol.2022.02.001

Julka BS, Patil SB, Chandrakiran C. Incidence and prevalence of fungal sinusitis in cases of chronic rhinosinusitis. Indian J Otolaryngol Head Neck Surg. 2023;75(Suppl 1):1041-1046. https://doi.org/10.1007/s12070-023-03572-0

Naz N, Ahmad Z, Malik SN, Zahid T. Diagnostic accuracy of CT scan in fungal sinusitis: diagnosis and extent. Ann Pak Inst Med Sci. 2016;12(2):61-65.

Abbasi HH, Batool F, Azam M, Qadir H, Shoaib M, Tariq Z. Diagnostic accuracy of CT PNS in diagnosing fungal sinusitis and its relation with endoscopy and histopathological findings. J Pak Soc Intern Med. 2024;5(4):745-749.

Iqbal J, Rashid S, Darira J, Shazlee MK, Ahmed MS, Fatima S. Diagnostic accuracy of CT scan in diagnosing paranasal fungal infection. J Coll Physicians Surg Pak. 2017;27(5):271-274.

Anand AM, George R, Padmanabhan E, Amirthalingam U. Diagnostic accuracy of computed tomography in fungal sinusitis: a case-control study. Int J Anat Radiol Surg. 2023;12(1):RO08-RO11. https://doi.org/10.7860/IJARS/2023/55429.2859

Lutfi IA, Maheswari N, Devi D, Afridi FI. Accuracy of computed tomography in characterizing the paranasal fungal infection. Pak J Med Dent. 2015;4(4):13-16.

Khattar VS, Hathiram B. Radiologic appearances in fungal rhinosinusitis. Otorhinolaryngol Clin (Int J). 2009;1(1):15-23. https://doi.org/10.5005/jp-journals-10003-1002

Middlebrooks EH, Frost CJ, De Jesus RO, Massini TC, Schmalfuss IM, Mancuso AA. Acute invasive fungal rhinosinusitis: a comprehensive update of CT findings and design of a diagnostic chart. AJNR Am J Neuroradiol. 2015;36(8):1529-1535. https://doi.org/10.3174/ajnr.A4295

Lanza DC, Dhong HJ, Tantilipikorn P, et al. Fungus and chronic rhinosinusitis: from bench to clinical understanding. Ann Otol Rhinol Laryngol Suppl. 2006;196:27-34. https://doi.org/10.1177/00034894061150s905

Khalid S, Dhanani R, Mughal A, Khan H, Wasif M. Diagnostic accuracy of CT scans in allergic fungal sinusitis: a cross-sectional study. J Clin Images Med Case Rep. 2022;3(11):2145. https://doi.org/10.52768/2766-7820/2145