Spring Brings Flowers and... Sinus Problems

CT is Modality of Choice for Complicated Sinusitis     Sinusitis is one of the most common complaints seen by primary care physicians as spring allergy season hits. Many cases can be diagnosed and treated effectively without using imaging; however, when treatment does not resolve recurrent or refractory problems, CT is usually the modality of choice.    X-rays typically don’t provide sufficient detail of the nasal anatomy to warrant their use and they are less able to detect sinus pathology, especially in the ethmoid and sphenoid sinuses. The cost of a limited CT scan now compares favorably with a full scale X-ray series, while providing far more diagnostic information.

MRI should be used chiefly to rule out tumors or fungal infection, as its ability to delineate bony structures is inferior to CT and its higher cost is not warranted for most patients.

Non-contrast coronal CT is adequate to detect polyps, osteomyelitis, and effects of injury or trauma. Contrast CT may be indicated in cases of complicated acute sinusitis, such as abscess or periorbital cellulitis, or to visualize vascular tumors. For many patients, a limited paranasal sinus study (coronal views) is sufficient; however, those with severe symptoms should have a complete exam (coronal and axial views). To enhance evaluation of disease and bony architecture, soft tissue and bony windows are valuable. CT findings should be correlated with clinical findings to decrease the likelihood of false positive findings.

CT is also an excellent tool for pre-surgical planning, providing good visualization of the complete osteomeatal complex and other structures. The coronal view correlates well with surgical findings.

If you have any questions, please do not hesitate to contact us at:
New Castle County: 302-999-XRAY (9729)
Sussex County: 302-644-XRAY (9729)