GIÁ TRỊ CỦA NỘI SOI MŨI XOANG, CẮT LỚP VI TÍNH VÀ CỘNG HƯỞNG TỪ TRONG CHẨN ĐOÁN VIÊM XOANG DO NẤM XÂM LẤN CẤP TÍNH

Abstract

Objective: To evaluate and compare the sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC) of nasal endoscopy, computed tomography (CT), and magnetic resonance imaging (MRI) in the diagnosis of AIFRS. Materials and Methods: A retrospective, descriptive study was conducted on 90 patients, divided into two groups: the AIFRS group (n=30) with histopathologically confirmed diagnosis, and a "non-fungal" control group (n=60) including 30 patients with acute bacterial rhinosinusitis and 30 patients with sinonasal cancer. Imaging data were independently and blindly reviewed. Logistic regression and ROC curve analysis were used to assess the diagnostic value of individual signs and combinations of signs. Results: The "sphenopalatine artery occlusion" sign on MRI demonstrated the highest diagnostic value (Se 79.3%, Sp 94.1%, AUC 0.89), followed by "intraoperatively observed mucosal necrosis" on endoscopy (Se 86.2%, Sp 85.0%, AUC 0.86). Individual CT signs had lower diagnostic value. The combination of multi-modal imaging yielded the best diagnostic performance. A model combining "intraoperatively observed mucosal necrosis" (endoscopy), "sphenoid sinus bone erosion" (CT), "sphenopalatine artery occlusion" (MRI), and "cavernous sinus thrombosis" (MRI) achieved a sensitivity of 85.7%, a specificity of 94.1%, and an AUC of 0.96. 'Cavernous sinus thrombosis' on MRI was the only statistically significant sign suggesting Mucorales infection over Aspergillus (p=0.038). Conclusion: MRI and nasal endoscopy are the most valuable tools for diagnosing AIFRS. Combining specific signs from all three modalities significantly improves diagnostic accuracy, facilitating early and effective clinical decision-making.