Longitudinal Magnetic Resonance Imaging Detects Onset and Progression of Chronic Rhinosinusitis from Infancy to School Age in Cystic Fibrosis

Rationale: Chronic rhinosinusitis (CRS) contributes to morbidity in patients with cystic fibrosis (CF). However, longitudinal data on CRS onset and progression is lacking. Objectives: To longitudinally evaluate CRS in CF from infancy to school age with paranasal sinus magnetic resonance imaging (MRI). Methods: A total of 64 children with CF (mean age at baseline, 1.1 +/- 1.6 yr; range, 0-5 yr) underwent a mean of 5.8 +/- 2.2 (range, 3-11 yr) subsequent annual MRI examinations. Additional 24 children (9.2 +/- 4.4 yr; range, 3-17 yr) homozygous for the F508del mutation underwent MRI before and at least 2 months after starting lumacaftor/ivacaftor. MRI was assessed using the previously evaluated CRS-MRI score. Results: In infancy, 65-87% of paranasal sinuses were opacified, and mucosal swelling was the dominant abnormality (58-97%). At preschool age (1-5 yr), 79-94% of sinuses were opacified (P< 0.05 vs. infancy), and mucosal swelling was the most dominant abnormality (79-94%; P< 0.05). At school age (at least 6 yr), almost all sinuses were opacified (71-99%; P< 0.001-0.357 vs. preschool age), and mucopyoceles were the dominant abnormality in maxillary and frontal sinuses (53-56%; P< 0.05-0.808). The CRS-MRI sum score increased from 22.4 +/- 9.6 in infancy to 34.2 +/- 9.6 in preschool age (P, 0.001) and was 34.0 +/- 5.7 in school age (P = 0.052). In children under lumacaftor/ivacaftor therapy, the CRS-MRI sum score (-0.5 +/- 3.3; P< 0.05) and maxillary sinus subscore (-0.5 +/- 1.5; P< 0.05) improved. Conclusions: Longitudinal paranasal sinus MRI detects an early onset and progression of the severity of CRS from infancy to school age, and response to lumacaftor/ivacaftor therapy in children with CF. Our data support its role in the comprehensive noninvasive monitoring of CRS in children with CF.