Beyin MR’ında saptanan insidental bulgular otolarengoloji pratiğinde klinik olarak ne kadar önemlidir?

Yıl 2016, Cilt: 6 Sayı: 3, 135 - 139, 31.12.2016

Çiğdem Kalaycık Ertugay Ayça Özbal Koç Halime Çevik Selim Sermed Erbek

Öz

Objective: We aimed to investigate the frequency of incidental diagnosis of paranasal sinus and mastoid abnormalities on brain magnetic resonance imaging (MRI) and its correlation with symptoms of patients.
Methods: We examined 100 patients who underwent brain MRI due to several different complaints other than sinusitis and mastoiditis. The patients who had any nasal or otologic pathology in otolaryngology examination were excluded from the study. Afterwards, a total of 65 patients were included into the study. The questionnaire consisted of otological symptoms and Sino-nasal Outcome Test (SNOT-20), Lund and Mackay scoring system for rhinosinusitis were filled by all patients immediately prior to imaging. The analysis of the MRI scan in terms of rhinosinusitis according to the Lund-Mackay radiological scoring and mastoiditis was performed by the same radiologist.
Results: The mean age of 65 patients was 46.62±17.73 years. Eighteen (27.7%) of these were men and 47 (72.3%) were women. In 26 (40%) of 65 patients, MRI demonstrated mastoiditis. We could not find any statistically significant correlation between mastoiditis and upper respiratory tract infection (p=0.896). There was no statistically significant relationship between radiological scores and total sinus symptom scores (p=0.93). Additionally, we could not find any correlation between radiological scores and SNOT-20 (p=0.923).
Conclusion: Our findings demonstrated that although some of these patients had various symptoms of sinus or mastoid diseases, these symptoms had no statistically significant correlation with the radiological diagnosis. In conclusion, radiologists should advise clinical correlation of their radiologic findings rather than reporting a clinical diagnosis such as sinusitis and mastoiditis.

Anahtar Kelimeler

Incidental findings, mastoiditis, MRI, paranasal sinus, rhinosinusitis

Kaynakça

• 1. Illes J, Kirschen MP, Edwards E, et al.; Working Group on Incidental Findings in Brain Imaging Research. Ethics. Incidental findings in brain imaging research. Science 2006;311:783–4.
• 2. Wolf SM, Lawrenz FP, Nelson CA, et al. Managing incidental findings in human subjects research: analysis and recommendations. J Law Med Ethics 2008;36:219–48.
• 3. Vernooij MW, Ikram MA, Tanghe HL, et al. Incidental findings on brain MRI in the general population. N Engl J Med 2007;357: 1821–8.
• 4. Yue NC, Longstreth WT Jr, Elster AD, Junqreis CA, O’Leary DH, Poirier VC. Clinically serious abnormalities found incidentally at MR imaging of the brain: data from the Cardiovascular Health Study. Radiology 1997;202:41–6.
• 5. Katzman GL, Dagher AP, Patronas NJ. Incidental findings on brain magnetic resonance imaging from 1000 asymptomatic volunteers. JAMA 1999;282:36–9.
• 6. Hartwigsen G, Siebner HR, Deuschl G, Jansen O, Ulmer S. Incidental findings are frequent in young healthy individuals undergoing magnetic resonance imaging in brain research imaging studies: a prospective single-center study. J Comput Assist Tomogr 2010;34:596–600.
• 7. Kim BS, Illes J, Kaplan RT, Reiss A, Atlas SW. Incidental findings on pediatric MR images of the brain. AJNR Am J Neuroradiol 2002;23:1674–7.
• 8. Reneman L, de Win MM, Booij J, van den Brink W, den Heeten GJ, Freling N, Majoie CB. Incidental head and neck findings on MRI in young healthy volunteers: prevalence and clinical implications. AJNR Am J Neuroradiol 2012;33:1971–4.
• 9. Sandeman EM, Hernandez Mdel C, Morris Z, et al. Incidental findings on brain MR imaging in older community-dwelling subjects are common but serious medical consequences are rare: a cohort study. PLoS One 2013;8:e71467.
• 10. Polat S, Aksoy E, Serin GM, Y›ld›z E, Tanyeri H. Incidental diagnosis of mastoiditis on MRI. Eur Arch Otorhinolaryngol 2011;268: 1135–8.
• 11. Meredith JR, Boyev KP. Mastoiditis on MRI: fact or artifact? Ear Nose Throat J 2008;87:514–8.
• 12. Orhan K, Nishiyama H, Tadashi S, Shumei M, Furukawa S. MR of 2270 TMJs: prevalence of radiographic presence of otomastoiditis in temporomandibular joint disorders. Eur J Radiol 2005;55: 102–7.
• 13. Mirza S, Malik TH, Ahmed A, Willatt DJ, Hughes DG. Incidental findings on magnetic resonance imaging screening for cerebellopontine angle tumours. J Laryngol Otol 2000;114:750–4.
• 14. Patel K, Chavda SV, Violaris N, Pahor AL. Incidental paranasal sinus inflammatory changes in a British population. J Laryngol Otol 1996;110:649–51.
• 15. Tarp B, Fiirgaard B, Christensen T, Jensen JJ, Black FT. The prevalence and significance of incidental paranasal sinus abnormalities on MRI. Rhinology 2000;38:33–8.
• 16. Gordts F, Clement PA, Destryker A, Desprechins B, Kaufman L. Prevalence of sinusitis signs on MRI in a non-ENT paediatric population. Rhinology 1997;35:154–7.
• 17. Lim WK, Ram B, Fasulakis S, Kane KJ. Incidental magnetic resonance image sinus abnormalities in asymptomatic Australian children. J Laryngol Otol 2003;117:969–72.
• 18. McNeill E, O’Hara J, Carrie S. The significance of MRI findings for non-rhinological disease. Clin Otolaryngol 2006;31:292–6.
• 19. Bhargavan M, Sunshine JH. Utilization of radiology services in the United States: levels and trends in modalities, regions, and populations. Radiology 2005;234:824–32.
• 20. Rao VM, Parker L, Levin DC, Sunshine J, Bushee G. Use trends and geographic variation in neuroimaging: nationwide medicare data for 1993 and 1998. AJNR Am J Neuroradiol 2001;22:1643–9.
• 21. Lund VJ, Mackay IS. Staging in rhinosinusitus. Rhinology 1993; 31:183–84.
• 22. Maroldi R, Farina D, Palvarini L, et al. Computed tomography and magnetic resonance imaging of pathologic conditions of the middle ear. Eur J Radiol 2001;40:78–93.
• 23. Migirov L. Computed tomographic versus surgical findings in complicated acute otomastoiditis. Ann Otol Rhinol Laryngol 2003;112: 675–7.
• 24. von Kalle T, Fabig-Moritz C, Heumann H, Winkler P. Incidental findings in paranasal sinuses and mastoid cells: a cross-sectional magnetic resonance imaging (MRI) study in a pediatric radiology department. Rofo 2012;184:629–34.
• 25. Lee DH, Jun BC, Park JO, Yeo SW. Magnetic resonance imaging of the mastoid cavity and middle ear: prevalence and clinical significance of incidental abnormal findings in a nonotolaryngologic adult and pediatric population. J Otolaryngol 2006;35:13–8.
• 26. Cooke LD, Hadley DM. MRI of the paranasal sinuses: incidental abnormalities and their relationship to symptoms. J Laryngol Otol 1991;105:278–81.
• 27. Manning SC, Biavati MJ, Phillips DL. Correlation of clinical sinusitis signs and symptoms to imaging findings in pediatric patients. Int J Pediatr Otorhinolaryngol 1996;37:65–74.