Neuroimaging clinics of North America
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The neoplastic lesions that can be found in the sinonasal space are numerous and varied. This article describes a general approach to narrowing down the differential diagnosis and provides the treating physician sufficient information to choose and deliver the best treatment modality. Computed tomography and MR imaging together provide complete radiologic assessment of sinonasal neoplasms.
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While most patients with inflammatory rhinosinusitis are successfully diagnosed clinically, imaging is indicated in patients with recurrent or chronic sinusitis, atypical symptoms and complicated acute sinusitis. Non-enhanced high resolution, thin section computed tomography (CT) is the reference standard in evaluating such patients. ⋯ Contrast MR imaging is preferred for assessing intraorbital or intracranial complications. The radiologist must have a systematic approach to sinonasal CT and generate a clinically relevant report that impacts patient management.
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As endoscopic sinus surgery (ESS) has evolved since its introduction to the United States, so has technology for imaging the sinonasal cavities. Although imaging is most frequently performed for evaluating chronic sinusitis refractory to medical therapy, its uses have expanded beyond inflammatory sinus disease. Multidetector Computed Tomography is the current workhorse for both diagnosis and preoperative planning in prospective ESS patients, while MR imaging remains a complementary tool for evaluating suspected tumors or intracranial and orbital complications of rhinosinusitis. In this article, the authors review current trends and potential future directions in the use of these modalities for sinus imaging.
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Fungal sinusitis is characterized into invasive and noninvasive forms. The invasive variety is further classified into acute, chronic and granulomatous forms; and the noninvasive variety into fungus ball and allergic fungal sinusitis. ⋯ This is particularly true of invasive fungal sinusitis, which typically affects immuno compromised patients and is associated with significant morbidity and mortality. Early diagnosis allows initiation of appropriate treatment strategies resulting in favorable outcome.
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Neuroimaging Clin. N. Am. · Nov 2015
ReviewPost-treatment Evaluation of Paranasal Sinuses After Treatment of Sinonasal Neoplasms.
The aim of imaging in the follow-up of asymptomatic patients treated for sinonasal neoplasms is to detect submucosal relapsing lesions. The challenge is to discriminate recurrent tissue within the changes resulting from unpredictable healing of tissue after surgery and radiotherapy. ⋯ Fluorodeoxyglucose-PET has a role in assessing distant metastasis. Its usefulness in local and regional surveillance has yet to be established.