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Sinonasal imaging

¹ Neuroradiology Department, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, ² Department of Clinical Radiology, University College London Hospitals NHS Foundation Trust, ³ Radiology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK

• CT is the initial imaging of choice for patients with symptoms of inflammatory paranasal sinus disease.
  
• The aim of imaging the paranasal sinuses is to confirm diagnosis, localize the disease, characterize the extent of pathology and describe any anatomical variations.
  
• An understanding of the anatomy is important for surgical planning and some normal variants can impair functional drainage pathways.
  
• As well as imaging findings in acute and chronic rhinosinusitis, there are five patterns of inflammatory disease. This classification helps the surgeon to elucidate whether surgery has a role and the type of surgery to perform.
  
• Beware of mimics of inflammatory disease such as tumours, odontogenic disease and cephalocoeles.
  
• A wide variety of neoplasms, both benign and malignant, may arise in the sinonasal cavity. Use the pattern of bony modelling to help distinguish aggressive and non aggressive masses.
  
• MRI is complementary to CT. T₂ weighted imaging is used for differentiating tumour and inflammatory mucosal secretions. Orbital, infratemporal, intracranial and perineural spread of disease is important.
  

The purpose of imaging the paranasal sinuses is to confirm diagnosis, localize the disease, characterize the extent of pathology and describe any anatomical variations. In this review article, we aim to demonstrate the complex anatomy, its variations and the appropriate imaging techniques. We will describe and illustrate the wide spectrum of disorders affecting the paranasal region and provide useful imaging features which are important for surgical planning and aid the differential diagnosis of sinonasal abnormality.