Radiology of the Nose and Paranasal Sinuses for the Endoscopic Sinus Surgeon

Abstract

■ Plain films are almost obsolete in the diagnostic workup of paranasal sinus disease. Acute sinusitis is a clinical, not a radiologic diagnosis. Chronic recurrent sinusitis, trauma, neoplastic disease, and malformations require more sophisticated (i.e., specific and sensitive) imaging techniques.

■ Computed tomography (CT) is the workhorse in paranasal sinus imaging. CT depicts not only the complex threedimensional anatomy, but also the extent of disease and the wide range of anatomic normal variations that are of great importance to the endoscopic surgeon.

■ Magnetic resonance imaging (MRI) is needed in selected cases. Its superb soft-tissue contrast makes it an ideal tool for searching for mucoceles, the delineation of tumors, and the degree of involvement of neural structures in malformations. In addition, plain MRI is able to show injury to the brain and dura mater in trauma patients.

■ Intrathecal administration of contrast medium (CT-cisternography, magnetic resonance cisternography) may be necessary to pinpoint the location of dural leaks, especially in complex cases of cerebrospinal fluid rhinorrhea.

■ Digital subtraction angiography is rarely needed for diagnostic purposes, but is employed for the preoperative devascularization of tumors that are prone to bleed at surgery, and for embolization of intractable epistaxis.