Comparison of MRI and CT in the Evaluation of Unilateral Maxillary Sinus Opacification

Abstract

Objectives. To evaluate the diagnostic performance of MRI compared with CT in differentiating neoplastic from infectious/inflammatory causes of complete unilateral maxillary sinus opacification (UMSO). Although MRI is increasingly used, no studies validate its utility compared to CT or nasal endoscopy in this context. Methods. A retrospective analysis of 49 patients presenting with complete UMSO to a tertiary referral centre was performed, investigated with both CT and MRI. Two head and neck radiologists independently reviewed each imaging modality and recorded both a final diagnosis and Likert-scale diagnostic certainty score. A consensus radiological diagnosis was determined, stratified into potentially neoplastic or infectious/inflammatory aetiology, and compared with nasal endoscopy and final diagnosis. Diagnostic performance and interoperator agreement for predicting neoplasia were calculated. Results. Both CT and MRI demonstrated high sensitivity and negative predictive value for neoplasm, although MRI was more specific (79%; 95% CI: 60–92%) than CT (14%; 95% CI: 4–32%), with a higher positive predictive value. MRI was more accurate (88%; 95% CI: 75–95%) than CT (49%; 95% CI: 34–64%) in diagnosing neoplasia. MRI had significantly higher diagnostic certainty Likert scores than CT ( p < 0.0001 for both observers). Interobserver agreement was fair for CT (kappa coefficient = 0.327) and excellent for MRI (kappa coefficient = 0.918). Conclusions. MRI is more specific than CT in characterising UMSO, with greater diagnostic certainty and reproducibility. The additive diagnostic value of MRI complements CT, potentially reducing diagnostic delays in some cases and the need for diagnostic endoscopic sinus surgery in others. We recommend MRI incorporation into the diagnostic pathway for patients with UMSO.

Study of Diagnostic Accuracy of Cone Beam Computed Tomography for Detection of Pathological and Anatomical Variations in Chronic Sinusitis Patients

“…Numerous anatomical variants contribute to chronic sinusitis by altering the mucociliary transport pattern and producing blockage in the ostiomeatal complex (OMC). Septal deviation is the most distinctive anatomical feature among the participants (5) .…”

Retrospective analysis of the risk of neoplasia associated with unilateral maxillary sinus opacification on computed tomography

“…

Neoplasia is a potential cause of unilateral maxillary sinus opacification on computed tomography Current guidelines advise a low threshold for early surgical management in isolated maxillary sinus opacification cases The rate of unilateral maxillary sinus opacification in this retrospective observational study of 641 scans was 9 per cent Of 52 patients, 1 inverted papilloma case was detected; this neoplasia rate of 2 per cent is lower than previously reported (11–34 per cent) A unilateral nasal polyp or mass was predictive of pathology that required operative management Careful history and examination of nasal cavity, oral cavity and orbit are paramount in triaging patients for further investigations to exclude neoplasia

Magnetic resonance imaging (MRI) has recently shown promise in the investigation of unilateral maxillary sinus opacification, with higher specificity and positive predictive values for neoplasia compared to CT. 16 Further research may be directed at evaluating the additive role of MRI in order potentially to mitigate the need for invasive biopsy in unilateral maxillary sinus opacification cases.…”

Radiological Imaging in Diagnosis and Management of Fungal Rhinosinusitis

“…MRI had significantly higher diagnostic certainty than CT. MRI is more specific than CT in diagnosing UMSO, with greater diagnostic certainty. 3 Hahnel et al in 1999 studied 30 patients who had inflammation of the paranasal sinuses. Both Coronal CT and coronal T1-weighted, MR imaging of the paranasal sinuses were performed in all patients.…”