Sinus Imaging for Diagnosis of Chronic Rhinosinusitis in Children

Abstract

Chronic rhinosinusitis (CRS) is a relatively common disease in children but is often overlooked because at times the clinical symptoms are subtle and nonspecific. This makes imaging very important in the diagnosis. Among the different techniques, plain radiography has limited utility,whereas CT scan and MRI have a major role in evaluating the modifications caused by the disease. In particular, a CT scan provides higher resolution of bone and soft tissue and removes the overlapping structures that are present in conventional radiography. CT is recommended in isolated sphenoid sinusitis, is essential in diagnosing fungal sinusitis, and is the technique of choice when orbital complications are suspected. MRI allows investigation of not only the morphology of structures, but their intrinsic biophysical and biochemical properties, such as water content, cellular density, lipid or blood product deposits, and fibrosis. MRI allows better soft tissue differentiation and high spatial resolution images depicting fine details. When indicated, MRI with contrast gadolinium-based agents may better characterize the local disease extension or its diffusion beyond paranasal and nasal cavities and has excellent contrast resolution. A combination of CT and MRI is useful in cases of diagnostic difficulties,especially when complications are involved.

Diagnostic Radiology

“…It is certainly useful in evaluating the extent of fungal sinus disease [24]. The CT scan defines soft tissue invasion, necrosis, early bone erosion and cavernous sinus thrombosis [25].…”

“…The CT scan defines soft tissue invasion, necrosis, early bone erosion and cavernous sinus thrombosis [25]. When findings are suggestive of fungal sinusitis but the diagnosis is uncertain, MRI with or without gadolinium is the best radiological means to further evaluate the disease [23,24,[26][27][28]. Central areas of hyperattenuation on CT correspond to hypointense signals on T1WI and signal void with T2WI MRI [29][30][31].…”

Pediatric Rhinosinusitis

“…The frontal sinuses continue to enlarge throughout adolescence. 3 Sinusitis denotes an inflammatory condition that may or not be associated with an infectious process. The intimate relationship, both anatomically and pathophysiologically, between the nose and paranasal sinuses has expanded the approach to sinus disease as evidenced by the term rhinosinusitis.…”

Rhinosinusitis in Children

“…Water and CaldwellLuc's views are taken for sinusitis. Haziness, opacification, or fluid level is suggestive of sinusitis [72]. CT scan of sinuses gives a better visualization and is a useful tool preoperatively.…”

“…For orbital and intracranial extensions or in AFS, MRI is more informative. In AFS, allergic mucin is hyperdense on T1W1 images with signal void on T2 imaging [72][73][74]. USG can be used for assessment of maxillary sinuses, but results are found to be inconsistent [75].…”