Value of ct Hounsfield units in differentiating non-invasive fungal rhinosinusitis
Main Article Content
Abstract
This study evaluated the diagnostic value of computed tomography Hounsfield unit measurements for differentiating non-invasive fungal rhinosinusitis from non-fungal chronic rhinosinusitis. This was a retrospective single-center diagnostic study including 340 operated patients with histopathologic confirmation, comprising 170 fungal and 170 non-fungal cases. Four HU metrics were measured within the sinus opacity. All HU parameters were significantly higher in the fungal group. Mean HU showed the best overall performance with an AUC of 0.901; an optimal cutoff of 42.4 HU yielded 90.0% sensitivity and 78.2% specificity. Maximum HU provided higher specificity with a cutoff of 143.25 HU. In multivariable analysis, mean HU, maximum HU, and age remained independent predictors. Combining HU measurements with qualitative CT findings further improved diagnostic performance, especially in patients without intralesional calcification. Hounsfield unit measurement is therefore a useful quantitative marker for the preoperative diagnosis of sinus fungus ball.
Article Details
Keywords
Non-invasive fungal rhinosinusitis, sinus fungus ball, chronic rhinosinusitis, Hounsfield unit, computed tomography
References
2. Deutsch PG, Whittaker J, Prasad S. Invasive and non-invasive fungal rhinosinusitis: a review and update of the evidence. Medicina (Kaunas). 2019;55(7):319. doi:10.3390/medicina55070319
3. Saibene AM, Allevi F, Biglioli F, et al. Comprehensive management of paranasal sinus fungus balls: a Young-IFOS consensus statement. Int Forum Allergy Rhinol. 2023;13(3):222-230. doi:10.1002/alr.23093
4. Ni Mhurchu E, Ospina J, Janjua AS, Shewchuk JR, Vertinsky AT. Fungal rhinosinusitis: a radiological review with intraoperative correlation. Can Assoc Radiol J. 2017;68(2):178-186. doi:10.1016/j.carj.2016.12.009
5. Tunç O, Yazıcı A, Aytaç İ, Tümüklü K, Akşamoğlu M. Value of Hounsfield units in the evaluation of isolated sphenoid sinus lesions. Allergy Rhinol (Providence). 2021;12:21526567211032560. doi:10.1177/21526567211032560
6. Ho CF, Lee TJ, Wu PW, et al. Diagnosis of a maxillary sinus fungus ball without intralesional hyperdensity on computed tomography. Laryngoscope. 2019;129(5):1041-1045. doi:10.1002/lary.27670
7. Fan YH, Wu PW, Huang YL, et al. Identifying a sphenoid sinus fungus ball using a nomogram model. Rhinology. 2023;61(2):153-160. doi:10.4193/Rhin22.329
8. Kim DH, Kwon JH, Koo HB, Lee JH. Clinical characteristics according to the radiological classifications of maxillary sinus fungus ball. J Rhinol. 2022;29(1):32-37. doi:10.18787/jr.2021.00392
9. Yang T, Liu C, Wang Y, Zhou J, Li Y, Wei H. Analysis of clinical characteristics of fungus ball based on the number of involved sinuses. Rhinology. 2025;63(2):230-236. doi:10.4193/Rhin23.501
10. Hoàng Thị Quyên, Hoàng Đình Âu. Giá trị của cắt lớp vi tính đa dãy trong chẩn đoán viêm xoang do nấm. Tạp chí Y học Việt Nam. 2023;526(2). doi:10.51298/vmj.v526i2.5573