ANALYSIS OF COMPUTED TOMOGRAPHY IMAGING FEATURES IN DIAGNOSIS OF ALLERGIC FUNGAL RHINOSINUSITIS VERSUS NON-FUNGAL CHRONIC RHINOSINUSITIS

Abstract

Background: Allergic Fungal Rhinosinusitis (AFRS) and Non-Fungal Chronic Rhinosinusitis (NFCRS) are distinct subtypes of chronic rhinosinusitis with differing treatments and prognoses. Early and accurate radiological distinction is critical. This study aimed to compare computed tomography (CT) imaging characteristics of AFRS and NFCRS to identify key distinguishing features.

Methods: A comparative cross-sectional study was conducted at the CT Scan Center, DHQ Hospital, Kasur, over four months. A total of 100 patients with clinically confirmed chronic rhinosinusitis were enrolled (15 AFRS, 85 NFCRS). Demographic, clinical, and CT imaging parameters were analyzed using the Chi square test (p < 0.05 significant).

Results: Most participants were male (61%) and aged 21–40 years (55%). Nasal obstruction was the most common symptom (88%), predominantly in NFCRS. CT findings showed highly significant associations with final diagnosis (p = 0.001). Moderate hyperdense sinus content was exclusive to AFRS (100%), while its absence was seen in 97.5% of NFCRS. Severe heterogeneous opacification (64% in AFRS), moderate sinus expansion (53% in AFRS), severe bony remodeling (38% in AFRS), and moderate to severe lamina papyracea erosion (100% in AFRS) were strongly associated with AFRS. Mild to moderate calcifications were exclusive to AFRS. Unilateral disease favored NFCRS (95%), whereas bilateral involvement was more common in AFRS (21%; p = 0.039).

Conclusion: CT imaging is essential for distinguishing AFRS from NFCRS. Hyperdense sinus content, severe heterogeneous opacification, sinus expansion, bony erosion, internal calcifications, multiple sinus involvement, and bilateral disease are highly suggestive of AFRS. These features improve diagnostic precision and guide appropriate clinical management