Diagnostic accuracy of nasal endoscopy, computed tomography and magnetic resonance imaging for chronic rhinosinusitis and sinonasal polyps: a systematic review and meta-analysis.

OBJECTIVE

To compare the diagnostic accuracy of nasal endoscopy, computed tomography and magnetic resonance imaging for chronic rhinosinusitis and chronic rhinosinusitis with nasal polyps.

METHODS

PubMed, Embase, Web of Science, Scopus and the Cochrane Library were searched from 1990 to August 2025. Studies reporting 2 × 2 diagnostic data for diagnostic nasal endoscopy, computed tomography or magnetic resonance imaging were pooled using random-effects models to estimate sensitivity, specificity and summary receiver-operating characteristic measures.

RESULTS

Nine diagnostic datasets were included. Diagnostic nasal endoscopy showed high sensitivity (0.87) but moderate specificity (0.63) versus computed tomography. Computed tomography demonstrated good sensitivity (0.90) but limited specificity (0.50) versus histopathology. Magnetic resonance imaging provided moderate sensitivity (0.71) and high specificity (0.88) versus computed tomography. Substantial heterogeneity existed across modalities and reference standards.

CONCLUSION

Diagnostic nasal endoscopy is highly sensitive but moderately specific. Computed tomography is sensitive but limited by false positives. Magnetic resonance imaging appears more specific, although evidence remains scarce. Further paired imaging-histopathology studies are required.