COMPUTED-TOMOGRAPHY (CT) IN THE DIAGNOSIS OF SINUS ASPERGILLOSIS

19 patients with radiodense sinus concretions found on standard radiography underwent a preoperative computed tomographic examination of the sinus maxillaris and the sinus concretions. 13 patients (68.4%) with the occurrence of radiodense concretions presented postoperative histologically and microbiologically diagnosed sinus aspergillosis infection. In 13 patients, the sinus concretions had a density higher than 2000 HU (Hounsfield unit) and 6 patients had concretions with a density lower than 2000 HU. 12 (92.3%) of 13 patients with concretions having a density greater than 2000 HU had a postoperatively diagnosed sinus aspergillosis infection. The incidence of diagnosed sinus aspergillosis increased from 68.4% by standard radiography to 92.3% by computed tomographic examination on the supposition that the concretions have a density higher than 2000 HU. The computer tomography (CT)-density of sinus concretions in patients with diagnosed sinus aspergillosis was 2826.7 +/- 362.8 HU. The concretions of patients without sinus aspergillosis had a lower density (788.1 +/- 916.8 HU; p < 0.001). CT-density of root filling material presented nearly the same number in patients with aspergillosis infection (2789.3 +/- 287.5 HU) and in patients without sinus aspergillosis infection (2635.0 +/- 367.8 HU). In patients with diagnosed sinus aspergillosis, a significant correlation between the density of sinus concretions and the density of adjoined dental root filling material was found. Our study demonstrates that an additional preoperative paranasal sinus CT inclusive densitometry of the sinus concretions present is more sensitive than standard radiography for predicting the diagnosis of sinus aspergillosis. CT densitometry also helps to confirm the dental origin of paranasal sinus concretions and may help to explain the possibility of a dental pathogenesis of sinus aspergillosis.