Skip to main content
SpringerLink
Log in

Imaging of the Nasal Cavity and the Sinuses

  • Chapter
  • First Online:
Airway diseases

  • 682 Accesses

Abstract

The role of direct radiography in sinonasal imaging is gradually decreasing. In both emergency trauma and elective cases, the main modality is computed tomography (CT). In particular, multiplanar high-resolution CT (HRCT) provides an excellent road map for functional endoscopic sinus surgery (FESS). A preoperative CT scan should be performed after the completion of medical treatment for mucosal disease. Nasal cleaning prior to the scan and using a nasal decongestant 15–10 min prior to the procedure facilitates radiological evaluation [1, 2]. In the postoperative period, CT should be performed 8 weeks later, by which time inflammation will have regressed and mucociliary activity will have normalized [3]. The HRCT images obtained should also be reconstructed in the soft tissue algorithm to reveal the attenuation of lesions, relationship of lesions with neighboring structures, and evaluate surrounding structures (brain, orbit, skull base, and nasopharynx). Unenhanced multiplanar HRCT is used in routine practice. Contrast-enhanced CT or magnetic resonance imaging (MRI) is performed to reveal the extension of pathologies from single-sided lesions, malignant or vascular lesions, and fungal spectrum to neighboring compartments, such as the brain and orbit [4].

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  1. Vaid S, Vaid N. Normal anatomy and anatomic variants of the paranasal sinuses on computed tomography. Neuroimaging Clin N Am. 2015;25(4):527548.

    Article  Google Scholar 

  2. Gwaltney JM Jr, Phillips CD, Miller RD, et al. Computed tomographic study of the common cold. N Engl J Med. 1994;330:25–30.

    Article  PubMed  Google Scholar 

  3. Figueroamon R. Imaging anatomy in revision sinus surgery. In: Kountakis SE, Jacobs J, Gosepath J, editors. Revision sinus surgery. Heidelberg: Springer; 2008. p. 1–11.

    Google Scholar 

  4. Wormald PJ. Imaging in endoscopic sinus surgery. In: Wormald PJ, editor. Endoscopic sinus surgery: anatomy, three-dimensional reconstruction and surgical technique. 3rd ed. New-York: Thieme Medical; 2013. p. 13–8.

    Google Scholar 

  5. Setzen G, Ferguson BJ, Han JK, et al. Clinical consensus statement: appropriate use of computed tomography for paranasal sinus disease. Otolaryngol Head Neck Surg. 2012;147:808–16. https://doi.org/10.1177/0194599812463848.

    Article  PubMed  Google Scholar 

  6. Hudgins PA, Mukundan S. Screening sinus CT: a good idea gone bad? AJNR Am J Neuroradiol. 1997;18(10):1850–4.

    CAS  PubMed  PubMed Central  Google Scholar 

  7. Huang BY, Senior BA, Castillo M. Current trends in sinonasal imaging. Neuroimaging Clin N Am. 2015;25:507–25. https://doi.org/10.1016/j.nic.2015.07.001.

    Article  PubMed  Google Scholar 

  8. Sen S, Chandra A, Mukhopadhyay S, Ghosh P. Imaging approach to sinonasal neoplasms. Neuroimaging Clin N Am. 2015;25(4):577–93.

    Article  PubMed  Google Scholar 

  9. Sasaki M, Sumi M, Eida S, et al. Multiparametric MR imaging of sinonasal diseases: time-signal intensity curve- and apparent diffusion coefficient-based differentiation between benign and malignant lesions. AJNR Am J Neuroradiol. 2011;32(11):2154–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Marquez S, Tessema B, Clement PA, et al. Development of the ethmoid sinus and extramural migration: the anatomical basis of this paranasal sinus. Anat Rec (Hoboken). 2008;291(11):1535–53.

    Article  PubMed  Google Scholar 

  11. Wolf G, Anderhuber W, Kuhn F. Development of the paranasal sinuses in children: implications for paranasal sinüs surgery. Ann Otol Rhinol Laryngol. 1993;102:705–11.

    Article  CAS  PubMed  Google Scholar 

  12. Shah RK, Dhingra JK, Carter BL, et al. Paranasal sinus development: a radiographic study. Laryngoscope. 2003;113:205–9. https://doi.org/10.1097/00005537-200302000-00002.

    Article  PubMed  Google Scholar 

  13. Güngör G, Okur N. Evaluation of paranasal sinus variations with computed tomography. Haydarpasa Numune Med J. 2019;59(4):320–7.

    Google Scholar 

  14. Kew J, Rees GL, Close D, et al. Multiplanar reconstructed computed tomography images improve depiction and understanding of the anatomy of the frontal sinus and recess. Am J Rhinol. 2002;16:119–23.

    Article  PubMed  Google Scholar 

  15. Shpilberg KA, Daniel SC, Doshi AH, et al. CT of anatomic variants of the paranasal sinuses and nasal cavity: poor correlation with radiologically significant rhinosinusitis but importance in surgical planning. AJR Am J Roentgenol. 2015;204(6):1255–60.

    Article  PubMed  Google Scholar 

  16. Bent JP, Cuilty-Siller C, Kuhn FA. The frontal cell as a cause of frontal sinus obstruction. Am J Rhinol. 1994;8(4):185–92.

    Article  Google Scholar 

  17. Sarna A, Hayman A, Laine F, et al. Coronal imaging of the ostiomeatal unit: anatomy of 24 variants. J Comput Assist Tomogr. 2002;26(1):153–7.

    Article  PubMed  Google Scholar 

  18. Kumar H, Choudhry R, Kakar S. Accessory maxillary ostia: topography and clinical application. J Anat Soc India. 2001;50:3–5.

    Google Scholar 

  19. Earwacker J. Anatomic variants in sinonasal CT. Radiographics. 1993;13:381–415.

    Article  Google Scholar 

  20. Welker KM, DeLone DR, Lane JI, Gilbertson JR. Arrested pneumatization of the skull base: imaging characteristics. Am J Roentgenol. 2008;190(6):1691–6.

    Article  Google Scholar 

  21. Beale TJ, Madani G, Morley SJ. Imaging of the paranasal sinuses and nasal cavity: normal anatomy and clinically relevant anatomical variants. Semin Ultrasound CT MR. 2009;30(1):2–16.

    Article  PubMed  Google Scholar 

  22. Cannon CR. Endoscopic management of concha bullosa. Otolaryngol Head Neck Surg. 1994;110:449–54.

    Article  CAS  PubMed  Google Scholar 

  23. Comer BT, Kincaid NW, Smith NJ, et al. Frontal sinus septations predict the presence of supraorbital ethmoid cells. Laryngoscope. 2013;123:2090–3.

    Article  PubMed  Google Scholar 

  24. Vaid S, Vaid N, Rawat S, et al. An imaging checklist for pre-FESS CT: framing a surgically relevant report. Clin Radiol. 2011;66(5):459–70.

    Article  CAS  PubMed  Google Scholar 

  25. Ohnishi T. Bony defects and dehiscences of the roof of the ethmoid bone. Rhinology. 1981;19:195–202.

    CAS  PubMed  Google Scholar 

  26. Keros P. On the practical value of differences in the level of the lamina cribrosa of the ethmoid. Z Laryngol Rhinol Otol. 1962;41:809–13.

    CAS  PubMed  Google Scholar 

  27. Kaplanoglu H, Kaplanoglu V, Dilli A, et al. An analysis of the anatomic variations of the paranasal sinuses and ethmoid roof using computed tomography. Eur J Med. 2013;45(2):115–25.

    Google Scholar 

  28. Rudmik L, Smith TL. Evaluation of the ethmoid skull base height prior to endoscopic sinus surgery: a preoperative CT evaluation technique. Int Forum Allergy Rhinol. 2012;2(2):151–4.

    Article  PubMed  PubMed Central  Google Scholar 

  29. O’Brien WT Sr, Hamelin S, Weitzel EK. The preoperative sinus CT: avoiding a “CLOSE” call with surgical complications. Radiology. 2016;281(1):10–21.

    Article  PubMed  Google Scholar 

  30. Moon HJ, Kim HU, Lee JG, et al. Surgical anatomy of the anterior ethmoidal canal in ethmoid roof. Laryngoscope. 2001;111(5):900–4.

    Article  CAS  PubMed  Google Scholar 

  31. Arrer E, Meco C, Oberascher G, et al. B-trace protein as a marker for cerebrospinal fluid rhinorrhea. Clin Chem. 2002;48:939–41.

    Article  CAS  PubMed  Google Scholar 

  32. Prosser JD, Vender JR, Solares CA. Traumatic cerebrospinal fluid leaks. Otolaryngol Clin N Am. 2011;44:857–73.

    Article  Google Scholar 

  33. Hiremath SB, Gautam AA, Sasindran V, et al. Cerebrospinal fluid rhinorrhea and otorrhea: a multimodality imaging approach. Diagn Interv Imaging. 2019;100(1):3–15.

    Article  CAS  PubMed  Google Scholar 

  34. Gülçek SY, Erdoğan A, Toprak U, et al. Evaluation of rhinorrhea by computed tomography cisternography. Tani Girisim Radyol. 2003;9:327–32.

    PubMed  Google Scholar 

  35. Bathla G, Moritani T. Imaging of cerebrospinal fluid leak. Semin Ultrasound CT MRI. 2016;37:143–9.

    Article  Google Scholar 

  36. Reddy M, Baugnon K. Imaging of cerebrospinal fluid rhinorrhea and otorrhea. Radiol Clin N Am. 2017;55:167–87.

    Article  PubMed  Google Scholar 

  37. Som PM, Brandwein MS, Wang B. Inflammatory diseases of the sinonasal cavities. In: Som PM, Curtin DC, editors. Head and neck imaging. 5th ed. St Louis: Elsevier; 2011. p. 167–251.

    Chapter  Google Scholar 

  38. Rak KM, Newell JD 2nd, Yakes WF, et al. Paranasal sinuses on MR images of the brain: significance of mucosal thickening. AJR Am J Roentgenol. 1991;156:381–4.

    Article  CAS  PubMed  Google Scholar 

  39. Zinreich SJ, Kennedy DW, Kumar AJ, et al. MR imaging of normal nasal cycle: comparison with sinus pathology. J Comput Assist Tomogr. 1988;12:1014–9.

    Article  CAS  PubMed  Google Scholar 

  40. Joshi VM, Sansi R. Imaging in sinonasal inflammatory disease. Neuroimaging Clin. 2015;25(4):549–68.

    Article  Google Scholar 

  41. Dillon WP, Som PM, Fullerton GD. Hypointense MR signal in chronically inspissated sinonasal secretions. Radiology. 1990;174:73–8.

    Article  CAS  PubMed  Google Scholar 

  42. Khattar VS, Hathiram BT. Radiologic appearances of fungal sinusitis. Otorhinolaryngol Clin Int J. 2009;1(1):15–23.

    Article  Google Scholar 

  43. Yousem DM. Imaging of sinonasal inflammatory disease. Radiology. 1998;188:303–14.

    Article  Google Scholar 

  44. Zeifer B. Update on sinonasal imaging: anatomy and inflammatory disease. Neuroimaging Clin N Am. 1998;8:607–30.

    CAS  PubMed  Google Scholar 

  45. Momeni AK, Roberts CC, Chew FS. Imaging of chronic and exotic sinonasal disease. Am J Roentgenol. 2017;189:S35–45.

    Article  Google Scholar 

  46. RaZ E, Win W, Hagiwara M, et al. Fungal sinusitis. Neuroimaging Clin. 2015;25(4):569–76.

    Article  Google Scholar 

  47. Yoon JH, Na DG, Byun HS, et al. Calcification in chronic maxillary sinusitis: comparison of CT findings with histopathologic results. AJNR Am J Neuroradiol. 1999;20:571–4.

    CAS  PubMed  PubMed Central  Google Scholar 

  48. DeMarcantonio MA, Han JK. Nasal polyps: pathogenesis and treatment implications. Otolaryngol Clin N Am. 2011;44:685–95.

    Article  Google Scholar 

  49. Chakrabarti A, Denning DW, Ferguson BJ, et al. Fungal rhinosinusitis: a categorization and definitional schema addressing current controversies. Laryngoscope. 2009;119(9):1809–18.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Cornelius RS, Martin J, Wippold FJ II, et al. ACR appropriateness criteria sinonasal disease. J Am Coll Radiol. 2013;10(4):241–6.

    Article  PubMed  Google Scholar 

  51. Aribandi M, McCoy VA, Bazan C III. Imaging features of invasive and noninvasive fungal sinusitis: a review. Radiographics. 2007;27(5):1283–96.

    Article  PubMed  Google Scholar 

  52. Glass D, Amedee RG. Allergic fungal rhinosinusitis: a review. Ochsner J. 2011;11(3):271–5.

    PubMed  PubMed Central  Google Scholar 

  53. de Shazo RD, O’Brien M, Chapin K, et al. Criteria for the diagnosis of sinus mycetoma. J Allergy Clin Immunol. 1997;99(4):475–85.

    Article  Google Scholar 

  54. Fatterpekar G, Mukherji S, Arbealez A, et al. Fungal diseases of the paranasal sinuses. Semin Ultrasound CT MR. 1999;20(6):391–401.

    Article  CAS  PubMed  Google Scholar 

  55. Groppo ER, El-Sayed IH, Aiken AH, et al. Computed tomography and magnetic resonance imaging characteristics of acute invasive fungal sinusitis. Arch Otolaryngol Head Neck Surg. 2011;137(10):1005–10.

    Article  PubMed  Google Scholar 

  56. de Shazo RD, Chapin K, Swain RE. Fungal sinusitis. N Engl J Med. 1997;337(4):254–9.

    Article  Google Scholar 

  57. Reddy CE, Gupta AK, Singh P, et al. Imaging of granulomatous and chronic invasive fungal sinusitis: comparison with allergic fungal sinusitis. Otolaryngol Head Neck Surg. 2010;143(2):294–300.

    Article  PubMed  Google Scholar 

  58. Alobid I, Guilemany JM, Mullol J. Nasal manifestations of systemic illnesses. Curr Allergy Asthma Rep. 2004;4:208–16.

    Article  PubMed  Google Scholar 

  59. Eggesbo HB, Dølvik S, Stiris M, et al. Complementary role of MR imaging of ethmomaxillary sinus disease depicted at CT in cystic fibrosis. Acta Radiol. 2001;42(2):144–50.

    Article  CAS  PubMed  Google Scholar 

  60. Bunnag C, Jareoncharsri P, Tansuriyawong P, et al. Characteristics of atrophic rhinitis in Thai patients at the Siriraj Hospital. Rhinology. 1999;37:125–30.

    CAS  PubMed  Google Scholar 

  61. Pace-Balzan A, Shankar L, Hawke M. Computed tomographic findings in atrophic rhinitis. J Otolaryngol. 1991;20:428–32.

    CAS  PubMed  Google Scholar 

  62. D’Anza B, Langford CA, Sindwani R. Sinonasal imaging findings in granulomatosis with polyangiitis (Wegener granulomatosis): a systematic review. Am J Rhinol Allergy. 2017;31(1):16–21.

    Article  PubMed  Google Scholar 

  63. Eggesbo HB. Radiological imaging of inflammatory lesions in the nasal cavity and paranasal sinuses. Eur Radiol. 2006;16:872–88.

    Article  CAS  PubMed  Google Scholar 

  64. Ruprecht A, Lam EVN. Paranasal sinuses. In: White SC, Pharoah MJ, editors. Oral radiology. Mosby Elsevier, St. Louispp; 2009. p. 506–40.

    Google Scholar 

  65. Bolger WE, Woodruff WW, Morehead J, et al. Maxillary sinus hypoplasia: classification and description of associated uncinate process hypoplasia. Otolaryngol Head Neck Surg. 1990;103(5):759–65.

    Article  CAS  PubMed  Google Scholar 

  66. Bassiouny A, Newlands WJ, Ali H, et al. Maxillary sinus hypoplasia and superior orbital fissure asymmetry. Laryngoscope. 1982;92:441–8.

    Article  CAS  PubMed  Google Scholar 

  67. Som PM, Shugar JM. The significance of bone expansion associated with the diagnosis of malignant tumors of the paranasal sinuses. Radiology. 1980;136(1):97–100.

    Article  CAS  PubMed  Google Scholar 

  68. Desai DD, Brandon BM, Perkins EL, et al. Staging of sinonasal and ventral skull base malignancies. Otolaryngol Clin N Am. 2017;50(2):257–71.

    Article  Google Scholar 

  69. Bist SS, Varshney S, Baunthiyal V, et al. Clinico-pathological profile of sinonasal masses: an experience in tertiary care hospital of Uttarakhand. Natl J Maxillofac Surg. 2012;3(2):180–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  70. Rao VM, El-Noueam KI. Sinonasal imaging. Anat Pathol Radiol Clin N Am. 1998;36(5):921–39.

    Article  CAS  Google Scholar 

  71. Koeller KK. Radiologic features of sinonasal tumors. Head Neck Pathol. 2016;10(1):1–12.

    Article  PubMed  PubMed Central  Google Scholar 

  72. Sun Q, An L, Zheng J, Zhu D. Advances in recurrence and malignant transformation of sinonasal inverted papillomas. Oncol Lett. 2017;13(6):4585–92.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  73. Som PM, Brandwein-Gensler MS, Kassel EE, et al. Tumors and tumor-like conditions of the sinonasal cavities. In: Som PM, Curtin HD, editors. Head and neck imaging. 5th ed. St Louis: Elsevier; 2011. p. 25–410.

    Google Scholar 

  74. Madani G, Beale TJ, Lund VJ. Imaging of sinonasal tumors. Semin Ultrasound CT MRI. 2009;30:25–38.

    Article  Google Scholar 

  75. Jiang J, Xiao Z, Tang Z, et al. Differentiating between benign and malignant sinonasal lesions using dynamic contrast-enhanced MRI and intravoxel incoherent motion. Eur J Radiol. 2018;98:7–13.

    Article  PubMed  Google Scholar 

  76. Pulickal GG, Navaratnam AV, Nguyen T, et al. Imaging Sinonasal disease with MRI: providing insight over and above CT. Eur J Radiol. 2018;102:157–68.

    Article  PubMed  Google Scholar 

  77. Agarwal M, Policeni B. Sinonasal neoplasms. Semin Roentgenol. 2019;54(3):244–57.

    Article  PubMed  Google Scholar 

  78. Maroldi R, Farina D, Battaglia G, et al. Magnetic resonance and computed tomography compared in the staging of rhinosinusal neoplasms. A cost-effectiveness evaluation. Radiol Med. 1996;91(3):211–8.

    CAS  PubMed  Google Scholar 

  79. Eggesbø HB. Imaging of sinonasal tumours. Cancer Imaging. 2012;12:136–52.

    Article  PubMed  Google Scholar 

  80. Barnes L, Bedetti C. Oncocytic Schneiderian papilloma: a reappraisal of cylindrical cell papilloma of the sinonasal tract. Hum Pathol. 1984;15:344–51.

    Article  CAS  PubMed  Google Scholar 

  81. Yang B, Li J, Dong J. MR imaging and CT features of oncocytic papilloma of the sinonasal tract with comparison to inverted papilloma. Br J Radiol. 2018;91(1090):20170957. https://doi.org/10.1259/bjr.20170957.

    Article  PubMed  PubMed Central  Google Scholar 

  82. McCollister KB, Hopper BD, Michel MA. Sinonasal neoplasms: update on classification, imaging features, and management. Appl Radiol. 2015;44(12):7–15.

    Article  Google Scholar 

  83. Hennessey PT, Reh DD. Chapter 9: benign sinonasal neoplasms. Am J Rhinol Allergy. 2013;27(Suppl 1):S31–4. https://doi.org/10.2500/ajra.2013.27.3893.

    Article  PubMed  Google Scholar 

  84. Wang YZ, Yang BT, Wang ZC, et al. MR evaluation of sinonasal angiomatous polyp. AJNR Am J Neuroradiol. 2012;33(4):767–72.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  85. Zou J, Man F, Deng K, et al. CT and MR imaging findings of sinonasal angiomatous polyps. Eur J Radiol. 2014;83(3):545–51.

    Article  PubMed  Google Scholar 

  86. Alimli AG, Ucar M, Oztunali C, et al. Juvenile nasopharyngeal angiofibroma: magnetic resonance imaging findings. J Belg Soc Radiol. 2016;100(1):63. https://doi.org/10.5334/jbr-btr.1090.

    Article  PubMed  PubMed Central  Google Scholar 

  87. Mafee MF. Nonepithelial tumors of the paranasal sinuses and nasal cavity. Role of CT and MR imaging. Radiol Clin N Am. 1993;13:75–9.

    Article  Google Scholar 

  88. Eller R, Mv S. Common fibro-osseous lesions of the paranasal sinuses. Otolaryngol Clin N Am. 2006;39:585–600.

    Article  Google Scholar 

  89. Eversole R, Su L, ElMofty S. Benign fibro-osseous lesions of the craniofacial complex. A review. Head Neck Pathol. 2008;2(3):177–202.

    Article  PubMed  PubMed Central  Google Scholar 

  90. Agarwal M, Michel MA. Sino-orbital pathologies: An approach to diagnosis and in identifying complications. Appl Radiol. 2017;46(8):8–20.

    Article  Google Scholar 

  91. Salina ACI, Souza PMM, Gadelha CMC, et al. Ossifying fibroma: an uncommon differential diagnosis for T2-hypointense sinonasal masses. Radiol Case Rep. 2017;12(2):313–7.

    Article  PubMed  PubMed Central  Google Scholar 

  92. Badger D, Aygun N. Imaging of perineural spread in head and neck cancer. Radiol Clin N Am. 2017;55(1):139–49.

    Article  PubMed  Google Scholar 

  93. Wu EL, Riley CA, Hsieh MC, et al. Chronic sinonasal tract inflammation as a precursor to nasopharyngeal carcinoma and sinonasal malignancy in the United States. Int Forum Allergy Rhinol. 2017;7(8):786–93.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Medical Faculty, Department of Radiology, Eskisehir Osmangazi University, Eskisehir, Turkey

    Ugur Toprak

  2. Irving Medical Center, Department of Radiology, Columbia University, New York, NY, USA

    Pamela Nguyen

Authors
  1. Ugur Toprak
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Pamela Nguyen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ugur Toprak .

Editor information

Editors and Affiliations

  1. Department of Otorhinolaryngology, Eskişehir Osmangazi University, Eskisehir, Türkiye

    Cemal Cingi

  2. Department of Pulmonology, Celal Bayar University, Manisa, Türkiye

    Arzu Yorgancıoğlu

  3. Department of Otorhinolaryngology, Kırıkkale University, Kırıkkale, Türkiye

    Nuray Bayar Muluk

  4. Federal University of Bahia School of Medicine and ProAR Foundation, Salvador - Bahia, Brazil

    Alvaro A. Cruz

Rights and permissions

Reprints and permissions

Copyright information

© 2023 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Toprak, U., Nguyen, P. (2023). Imaging of the Nasal Cavity and the Sinuses. In: Cingi, C., Yorgancıoğlu, A., Bayar Muluk, N., Cruz, A.A. (eds) Airway diseases. Springer, Cham. https://doi.org/10.1007/978-3-031-22483-6_11-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-22483-6_11-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-22482-9

  • Online ISBN: 978-3-031-22483-6

  • eBook Packages: MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation