Imaging

Sinusitis

Preliminary Diagnosis: Sinusitis

I. What imaging technique is first-line for this diagnosis?

  • CT sinuses with and without contrast with coronal and sagittal reconstructions.

II. Describe the advantages and disadvantages of this technique for diagnosing sinusitis.

Advantages

  • Relatively inexpensive and fast imaging modality.

  • Evaluates the adjacent osseous structures for underlying erosion and can date the chronicity of the sinus inflammatory process.

  • Able to evaluate for fungal colonization.

Disadvantages

  • Exposes patients to ionizing radiation.

III. What are the contraindications for the first-line imaging technique?

May be contraindicated in pregnant patients.

IV. What alternative imaging techniques are available?

  • MRI of the brain with and without contrast.

V. Describe the advantages and disadvantages of the alternative techniques for diagnosing sinusitis.

Advantages

  • Does not expose the patient to ionizing radiation.

Disadvantages

  • Poor for evaluating the surroudning osseous structures.

  • Less specific and sensitive in evaluating for fungal sinus infection.

  • Expensive.

  • Time consuming.

  • Requires significant patient cooperation to minimize motion artifact.

  • May be subject to dental hardware artifact or motion artifact, degrading quality of the image.

VI. What are the contraindications for the alternative imaging techniques?

  • Contraindicated in patients with non-MR compatible hardware.

  • Gadolinium contrast is contraindicated in patients with a GFR ≤ 30.

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