Onset and development of chronic rhinosinusitis from infancy through adolescence in primary ciliary dyskinesia detected by longitudinal magnetic resonance imaging.

RATIONALE: A cross-sectional study employing magnetic resonance imaging (MRI) of paranasal sinuses recently showed a high prevalence and extent of chronic rhinosinusitis (CRS) in children with primary ciliary dyskinesia (PCD). However, longitudinal imaging data on CRS onset and progression are lacking.

OBJECTIVE

To longitudinally evaluate CRS in PCD from infancy through adolescence with MRI.

METHODS

22 children with PCD (median baseline age 8.5 year, range 0.0-18.0 year) underwent a median of 3 (range 1-9) annual standardized paranasal sinus MRI examinations. MRI were assessed by 2 independent readers using the previously evaluated CRS-MRI score, including assessment of the prevalence and dominance (defined as the most prominent abnormality within a sinus) of each abnormality.

RESULTS

At infancy (0 year), 83%-100% of paranasal sinuses and mastoid cells were opacified. Mucosal swelling was the most prevalent (83%-100%) and in most sinuses the dominant abnormality (50%-100%). In maxillary sinuses, also polyps (75%) and mucopyoceles (13%) were prevalent. At preschool age (1-5 year), the prevalence of opacified sphenoid sinus increased (83% vs. 100%, P < .01), while the prevalence of opacification was stable for the other sinuses as well as for mastoid cells (P = .567-0.999 vs. infancy). Mucosal swelling remained the most prevalent (100%) and dominant abnormality (47%-100%). In maxillary sinuses, the prevalence and subscore of mucopyoceles increased (81% vs. 13% and 2.0 ± 1.6 vs. 4.1 ± 2.1, respectively; P < .05), while polyps were stable (70% vs. 75%, P > .999 vs. infancy). At school age (≥6 year), almost all maxillary, sphenoid and ethmoid sinuses (91%-100%), and 87% of mastoid cells were opacified (P = .122-.999 vs. preschool age). Especially in maxillary sinuses, the prevalence of mucopyoceles, polyps and sinus deformation decreased (60% vs. 81%, 40% vs. 70%, and 51% vs. 78%, respectively; P < .05 vs. preschool age). The CRS-MRI sum score averaged 27.8 ± 4.9 at infancy, was stable at preschool age (31.9 ± 5.6, P > .999) and decreased at school age to 25.6 ± 8.3 (P < .01).

CONCLUSIONS

Longitudinal paranasal sinus MRI detects high prevalence and extent of paranasal sinuses abnormalities from infancy. Our data support its role for comprehensive non-invasive monitoring of CRS in children with PCD.