CT Imaging Biomarkers in Rhinogenic Contact Point Headache: Quantitative Phenotyping and Diagnostic Correlations

settings Order Article Reprints Open AccessArticle CT Imaging Biomarkers in Rhinogenic Contact Point Headache: Quantitative Phenotyping and Diagnostic Correlations by Salvatore Lavalle 1 [ORCID] , Salvatore Ferlito 2 [ORCID] , Jerome Rene Lechien 3,4 [ORCID] , Mario Lentini 1,5 [ORCID] , Placido Romeo 6, Alberto Maria Saibene 3,7 [ORCID] , Gian Luca Fadda 8,† [ORCID] and Antonino Maniaci 1,3,4,5,*,† [ORCID] 1 Department of Medicine and Surgery, School of Medicine, University of Enna “Kore”, 94100 Enna, Italy 2 Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, 95125 Catania, Italy 3 Research Committee, Young Otolaryngologists of the International Federation of Otorhinolaryngological Societies, 70123 Paris, France 4 Department of Surgery, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), 7000 Mons, Belgium 5 ASP Ragusa-Hospital Giovanni Paolo II, 97100 Ragusa, Italy 6 Division of Radiology San Marco Hospital, AOU Policlinico “G. Rodolico” San Marco, 95121 Catania, Italy 7 Department of Otolaryngology-Head and Neck Surgery, University of Milan, 20019 Milan, Italy 8 Department of Otolaryngology, University of Turin, “San Luigi Gonzaga” Hospital, 10043 Turin, Italy * Author to whom correspondence should be addressed. † These authors contributed equally to this work. J. Imaging 2025, 11(10), 362; https://doi.org/10.3390/jimaging11100362 Submission received: 13 September 2025 / Revised: 11 October 2025 / Accepted: 11 October 2025 / Published: 14 October 2025 (This article belongs to the Section Medical Imaging) Download keyboard_arrow_down Browse Figures Versions Notes Abstract Rhinogenic contact point headache (RCPH) represents a diagnostic challenge due to different anatomical presentations and unstandardized imaging markers. This prospective multicenter study involving 120 patients aimed to develop and validate a CT-based imaging framework for RCPH diagnosis. High-resolution CT scans were systematically assessed for seven parameters: contact point (CP) type, contact intensity (CI), septal deviation, concha bullosa (CB) morphology, mucosal edema (ME), turbinate hypertrophy (TH), and associated anatomical variants. Results revealed CP-I (37.5%) and CP-II (22.5%) as predominant patterns, with moderate CI (45.8%) and septal deviation > 15° (71.7%) commonly observed. CB was found in 54.2% of patients, primarily bulbous type (26.7%). Interestingly, focal ME at CP was independently associated with greater pain severity in the multivariate model (p = 0.003). The framework demonstrated substantial to excellent interobserver reliability (κ = 0.76–0.91), with multivariate analysis identifying moderate–severe CI, focal ME, and specific septal deviation patterns as independent predictors of higher pain scores. Our imaging classification system highlights key radiological biomarkers associated with symptom severity and may facilitate future applications in quantitative imaging, automated phenotyping, and personalized treatment approaches