The utility of CT sinus screening in the pre-bone marrow transplant evaluation

Abstract Background: Patients undergoing allogeneic bone marrow transplantation (BMT) are immunocompromised due to prolonged myelosuppression as part of their induction regimen. In addition, immunosuppressive medications are necessary and put patients at increased risk for infections, including potentially severe sinus infections. CT sinus imaging is commonly used to screen for occult or active sinonasal disease with the rationale that identifying and treating such infections preemptively may prevent post-transplant complications. However, the true utility of routine CT sinus screening in this context remains unclear, particularly when findings are asymptomatic or incidental. This study aims to assess whether CT sinus imaging prior to allogeneic BMT guides clinical management decisions, such as initiating otolaryngology (ENT) evaluation or surgical intervention, and whether it contributes to delays in transplant timing. By evaluating patterns of imaging findings, subsequent interventions, and timing of transplantation, we aim to determine the clinical value of this widely used screening practice. Methods: A retrospective chart review was conducted on 343 patients who underwent allogeneic BMT from 2000 to 2024 at the Georgia Cancer Center. Patients were included if they received CT sinus imaging as part of their pre-transplantation evaluation. Patients who underwent CT sinus imaging more than 90 days prior to BMT were excluded to minimize outliers and account for potential confounding factors that may have contributed to severe delays in transplantation. Imaging findings were categorized as positive or negative based on the presence of significant mucosal thickening, sinus opacification, air-fluid levels, or other radiographic evidence of infection or structural abnormality. Subsequent medical records were then reviewed to determine whether patients with positive findings were referred to ENT, underwent further diagnostic procedures, or received medical or surgical intervention. Additionally, the time interval from CT sinus imaging to transplant was compared between patients with and without positive findings to assess for potential delays. Statistical significance was assessed using a two-tailed unpaired t-test, with significance considered at p0.05. Results: Out of 343 patients reviewed, 200 patients had a CT sinus evaluation within 90 days prior to BMT. 45 of those patients (23%) had positive findings on CT sinus imaging. Despite this, only 6 patients (3% of the total cohort with CT sinus imaging) were referred to ENT for further evaluation. Of the six patients referred to ENT, only one underwent a procedural intervention involving the removal of a nasal polyp, and another was diagnosed with acute sinusitis, for which they continued the systemic antibiotics already prescribed. The average time from CT sinus imaging to transplant was 46 days for both the group with positive findings and the group with negative findings, with no statistically significant difference in time to transplant (p=0.55). This data suggests that imaging findings did not lead to meaningful alterations in clinical management or delays in transplantation. Conclusions: Routine CT sinus imaging as part of the pre-transplant evaluation for allogeneic BMT patients does not appear to significantly influence clinical decision-making or delay transplantation. Given that 97% of patients with a CT sinus screening did not receive any further evaluation or treatment, and that patients did not experience a transplant delay as a result of imaging findings, the value of this screening practice should be reconsidered. These findings support a more selective approach to CT sinus imaging, perhaps one reserved for patients with clinical symptoms or a known history of chronic sinus disease.