Radiological imaging in sinusitis.pptx
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sinusitis , imaging , radiology , otolaryngology , PNS
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Radiological imaging in sinusitis.pptx
- 1. Radiological Imaging in sinusitis Dr Khalil Elkahlout ENT Resident R2 Supervisor : Dr Mohammad Murad Department of Otolaryngology Alshifa medical complex, Gaza الرحيم الرحمن هللا بسم
- 2. contents - - Introduction - Acute Rhinosinusitis - Chronic Rhinosinusitis - Sinonasal Polyposis - Complications of Rhinosinusitis - Allergic Fungal Sinusitis - Sinus Mycetoma - Invasive Fungal Sinusitis
- 3. CT versus MRI images X-RAY AND COMPUTED TOMOGRAPHY (CT) Map of density of tissues in the body according to degree of X-ray beam attenuation . On X-ray and CT images ; white = high density “Hyperdense”. Black = low density “hypodense” Gray = intermediate density “ isodense “ MAGNETIC RESONANCE IMAGING (MRI) MRI images are a map of proton energy within tissue of the body T1 images – 1 tissue type is bright – FAT T2 images – 2 tissue types are bright – FAT and WATER On MRI images white = high signal = “Hyperintense” signal.
- 5. • Protocol advice ○ Bone CT – Axial ≤ 1-mm slice thickness with coronal, sagittal reconstructions to evaluate drainage pathways ○ MRI – Multiplanar T1 and T2 sequences necessary – C+ T1 with fat suppression best for intracranial/orbital complications
- 9. Chronic rhinosinusitis with polyposis (CRSwP)
- 13. Allergic fungal sinusitis (AFS)
- 16. Granulomatous
- 19. THANK YOU 1 9
Editor's Notes
- NECT ○ Air-fluid level,frothy secretions ○ mucosal thickening > 1 cm CECT ○ Indicated when orbital or intracranial complications suspected clinically ○ Inflamed sinus mucosa enhances, but soft tissue deep to mucosa does not & Central secretions do not enhance • T1WI ○ Mucosal thickening isointense ○ Air/fluid level ○ Hyperintense secretions when chronic sinusitis present • T2WI ○ Secretions ↓ SI when proteinaceous or chronic
- Bone CT ○ Mucosal thickening or opacification of sinus + ○ Bony walls of sinus thickened & sclerotic (osteitis) ○ Variable density of secretions – Isodense to hyperdense depending on protein, water, fungal content – Hyperdense secretions may be secondary to inspissated mucus or fungal sinusitis ○ Occasional calcification may be present ○ Mucus retention cysts and polyps are common • T1WI ○ Thickened mucosa isointense. ○ Variable signal of retained secretions depending on variable water & protein content – Higher protein content causes higher T1 signal • T2WI ○ Mucosa typically hyperintense ○ Retained secretions range from hyperintense (↑ water content) to hypointense (↓ water, desiccated) ○ Thickened sinus walls evident on T2 MR
- NECT ○ Primarily mucoid or soft tissue density – May be hyperdense with ↑ protein, ↓ water content, or colonization with fungal elements • CECT ○ Mucosal enhancement at periphery of polyps – No central enhancement (as seen with neoplasms) • Bone CT ○ Multiple, polypoid, soft tissue masses within nasal cavity and paranasal sinuses ○ Remodeling of sinonasal bones common in severe cases • T1WI ○ Fresh mucus (high water content) is hypointense ○ Bizarre mixture of layered signals seen in sinuses and nose – Results from polyps mixed with various ages of mucus • T2WI ○ Fresh mucus is hyperintense ○ Chronic, inspissated mucus can appear low signal (mimics air) • T1WI C+ ○ Thin mucosal enhancement between polypoid soft tissue lesions without central enhancement
- SPA: Peripherally enhancing, central low-density mass ○ CST: Heterogeneously enhancing, enlarged cavernous sinus with enlarged or thrombosed superior ophthalmic vein (SOV) ○ EDA & SDE: fluid collection in epidural or subdural space, with reduced diffusivity & enhancing adjacent meninges ○ Cerebral abscess: Ring-enhancing mass in parenchyma with uniformly thick walls, central reduced diffusivity, & surrounding vasogenic edema
- NECT ○ Hyperdense material centrally within opacified sinuses With Hypodense rim of mucosa • T1WI ○ Signal variable (water, protein, & fungal content) • T2WI ○ Hypointense signal centrally due to dense fungal concretions & heavy metals; may mimic air • T1WI C+ ○ Peripheral inflamed mucosa enhances
- Bone CT ○ Opacification within sinus ○ Central areas of high density ± calcification ○ Chronic mucoperiosteal change may be minor • T1WI ○ Variable signal material in affected sinus ○ Hypointense T1 signal due to absence of free water in thick, solid, mycetomatous mass • T2WI ○ Hypointense signal due to macromolecular protein binding may be mistaken for air
- • NECT ○ Earliest finding = unilateral nasal soft tissue thickening ○ Complete or partial soft tissue opacification of sinus; mucosal thickening ○ Hyperattenuation of secretions suggests fungal infection; more typical of chronic than acute ○ Focal areas of sinus wall erosion ○ Infiltration of adjacent fat & soft tissues • T1WI ○ Variable signal of material within involved sinus ○ ↓ signal (similar to soft tissue) within periantral fat – Key sequence for identifying infiltration of fat planes • T2WI ○ Variable signal of sinus secretions – Fungal elements may cause hypointense T2 signal ○ High signal edema with fat suppression • T1WI C+ ○ Loss of contrast enhancement lesions – Nonenhancing, hypointense mucosa (black turbinate sign) corresponds with necrotic eschar ○ Enhancement of involved soft tissues ○ Leptomeningeal enhancement