Clinical evaluation of radiation-induced sinusitis by MRI-based scoring system in nasopharyngeal carcinoma patients

Abstract

Objective: To explore the application of magnetic resonance imaging (MRI) in the evaluation of radiation-induced sinusitis (RIS), MRI-based scoring system was used to evaluate the development regularity, characteristics and influencing factors of RIS in nasopharyngeal carcinoma (NPC) patients.

Patients and methods: A retrospective analysis was performed by collecting the clinical and MRI data of 346 NPC patients to analyze the characteristics and prognosis of RIS. The predictive model was constructed according to the influencing factors of RIS.

Results: (1) In the 2-year follow-up after radiotherapy (RT), there was significant change in L-M score in both groups of NPC patients (sinusitis before RT group: p = 0.000 vs. non-sinusitis before RT group: p = 0.000). After 6 months of RT, the L-M scores of the two groups tended to plateau (sinusitis before RT group: p = 0.311 vs. non-sinusitis before RT group: p = 0.469). (2) The prevalence of sinusitis in two groups of NPC patients (without or with sinusitis before RT) was 83% vs. 93%, 91% vs. 99%, 94% vs. 98% at 1, 6 and 24 months after RT, respectively. (3) In the patients without sinusitis before RT, the incidence of sinusitis in maxillary and anterior/posterior ethmoid, sphenoid and frontal sinuses was 87.1%, 90.0%/87.1%, 49.5%, 11.8% respectively, 1 month after RT. (4) A regression model was established according to the univariate and multivariate analysis of the factors related to RIS (smoking history: p = 0.000, time after RT: p = 0.008 and TNM staging: p = 0.040).

Conclusion: (1) RIS is a common complication in NPC patients after RT. This disorder progressed within 6 months after RT, stabilized and persisted within 6 months to 2 years. There is a high incidence of maxillary sinus and ethmoid sinus inflammation in NPC patients after RT. (2) Smoking history, time after RT and TNM staging were significant independent risk factors for RIS. (3) The intervention of the risk factors in the model may prevent or reduce the occurrence of RIS in NPC patients.

Keywords: Evaluation; MRI; NPC; Radiation-induced sinusitis; Risk factor.

Fig. 1

Changes of L-M score (MRI) in NPC patients before and after RT

Fig. 2

The Changes of RIS prevalence during 24 months follow-up time in two groups

Fig. 3

The prevalence of different sinus inflammation in all NPC patients based on MRI findings

Fig. 4

Prognostic nomogram for RIS of NPC patients Time = post-RT months for NPC (1 = 1 month, 2 = 3 months, 3 = 6 months, 4 = 9 months, 5 = 12 months, 6 = 18 months, 7 = 24 months), TNM = clinical stage of NPC (1 = stage I, 2 = stage II, 3 = stage III, 4 = stage IV), smoke = smoking history (0 = no, 1 = yes)

Fig. 5

ROC curve for the logistic regression model in group B It showed that the model had a modest discriminatory ability (AUC = 0.692, 95%CI = 0.631–0.753, p < 0.05)