State of the Art Diagnostic Imaging of Paranasal Sinus Disease

Abstract

The following article describes a diagnostic concept of paranasal sinus imaging, based on more than 10 years close collaboration of the authors. CT and MR are the primary imaging modalities for investigating paranasal sinus lesions. Conventional X-ray images add little information due to insufficient sensitivity. Angiography is restricted to those patients who require preoperative tumor embolization or emergency treatment of intractable epistaxis. After thorough medical treatment of inflammatory paranasal sinus disease, CT becomes the method of choice to clearly depict preoperative osseous anatomy and to distinguish between benign and malignant intraosseous lesions. In cases where trauma is involved, CT easily identifies anterior skull base fractures. Moreover, CT will be the first step to localize early or late CSF rhinorrhea. MR, with its ability to distinguish between different soft tissues, compliments CT. This holds particularly true for inflammatory or neoplastic disease close to the skull base, orbital apex and cavernous sinus. The signal intensity in T(1) and T(2) weighted images provides additional information with respect to cellularity and vascularization of lesions, which has important diagnostic and therapeutic implications.

Exclusively endoscopic approach for juvenile angiofibroma in an adult – a case report

“…It tends to show bone remodelling rather than aggressive destruction, although the tumour may directly invade bone. In contrast, according to Schuknecht et al [10] computed tomography images of sinonasal malignancy typically demonstrate bone destruction, which did not correspond with the radiological findings in our case. However, the size of the tumour in our case allowed the assumption of malignancy at the early stage.…”

Neonatal disseminated methicillin-resistant Staphylococcus aureus presenting as orbital cellulitis

“…25 Imaging CT scan is currently the imaging tool of choice as it is a relatively inexpensive and quick procedure and it shows the bony details very well. However, it is not very useful for examining the orbital apex 26 or assessing the response to medical treatment as, during the first few days of treatment, CT shows enlargement of the SPA regardless of the ultimate response. 27 CT has an overall accuracy of 91 per cent, which is due to underestimation of the disease severity in orbital cellulitis.…”

Comprehensive review on endonasal endoscopic sinus surgery

“…Table 1 (Tab. 1) gives an overview of existing evaluation systems and CT check lists [ 50 ], [ 51 ], [ 52 ], [ 56 ], [ 76 ], [ 77 ], [ 78 ], [ 79 ], [ 80 ], [ 81 ], [ 82 ], [ 83 ], [ 84 ]. Recommendations of literature try to restrict analysis of imaging to 5 defined general analytical steps [ 83 ].…”