Comparison of CT and MRI features in sinusitis

Magnetic Resonance Imaging Features of the Sphenoid Sinus in Patients with Non-Functioning Pituitary Adenoma

Background and Objectives: A magnetic resonance imaging (MRI) scan is part of the diagnostic protocol in pituitary adenoma patients. The goal of the present study is to present and analyse the MRI appearances of the sphenoid sinus (SS) in patients with non-functioning pituitary adenoma (NFPA). Materials and Methods: This is a retrospective case-control study conducted between January 2015 and December 2023 in a tertiary referral hospital. Forty NFPA patients were included in the study group, while the control group consisted of 30 age- and gender-matched cases. Results: The sellar type of SS pneumatization was the most frequently encountered pattern among both groups. The presence of the lateral recess of the SS, mucosal cysts, and sphenoethmoidal cells was similar in both patient groups. The proportion of patients with SS mucosal thickness greater than 3 mm was 42.5% in NFPA group and 3% in the control group, and this difference was statistically significant (p < 0.001). The space between the two optic nerves was significantly larger in the NFPA group as compared to the control group (p < 0.001). Conclusions: Our study was able to establish a statistically significant association between the presence of NFPA and both the thickening of the SS mucosa and increased space between optic nerves.

Evaluation of the efficacy of diffusion-weighted magnetic resonance imaging and apparent diffusion coefficients in the diagnosis of maxillary diseases

OBJECTIVE

We investigated the efficacy of using diffusion-weighted imaging (DWI) with quantitative apparent diffusion coefficient (ADC) mapping in the diagnosis of maxillary diseases.

STUDY DESIGN

We evaluated 146 cases of maxillary diseases (32 malignant tumors, 11 benign tumors, 28 maxillary cysts, 60 cases of maxillary sinusitis, and 15 maxillary sinus retention cysts) that had been examined using magnetic resonance imaging. The DWI sequence was obtained with b values of 0 and 800 s/mm2 and ADC values were calculated. We used one-way analysis of variance and the Tukey honestly significant difference test to identify differences within and between the types of diseases.

RESULTS

Mean ADC values for malignant tumors (1.07 × 10-3 mm2 s-1) were significantly lower than ADCs for benign tumors (1.85 × 10-3 mm2 s-1), maxillary cysts (1.77 × 10-3 mm2 s-1), maxillary sinusitis (2.34 × 10-3 mm2 s-1), and maxillary sinus retention cysts (2.52 × 10-3 mm2 s-1), with P < 0.001.   Mean ADC differed significantly between all disease types except between maxillary sinusitis and maxillary sinus retention cysts. ADC values also significantly differed between specific lesions within the malignant tumor and maxillary cyst groups.

CONCLUSIONS

The use of ADC values can be useful in the differential diagnosis of malignant maxillary diseases, benign lesions, cysts, and inflammatory and reactive conditions.

Visualization of clinically silent, odontogenic maxillary sinus mucositis originating from periapical inflammation using MRI: a feasibility study

OBJECTIVES

Maxillary sinus mucositis is frequently associated with odontogenic foci. Periapical inflammation of maxillary molars and premolars cannot be visualized directly using radiation-based imaging. The purpose of this study was to answer the following clinical question: among patients with periapical inflammatory processes in the maxilla, does the use of magnetic resonance imaging (MRI), as compared to conventional periapical (AP) and panoramic radiography (OPT), improve diagnostic accuracy?

METHODS

Forty-two subjects with generalized periodontitis were scanned on a 3 T MRI. Sixteen asymptomatic subjects with mucosal swelling of the maxillary sinus were enrolled in the study. Periapical edema was assessed using short tau inversion recovery (STIR) sequence. Apical osteolysis and mucosal swelling were assessed by MRI, AP, and OPT imaging using the periapical index score (PAI). Comparisons between groups were performed with chi-squared tests with Yates' correction. Significance was set at p < 0.05.

RESULTS

Periapical lesions of maxillary premolars and molars were identified in 16 subjects, 21 sinuses, and 58 teeth. Bone edema and PAI scores were significantly higher using MRI as compared to OPT and AP (p < 0.05). Using the STIR sequence, a significant association of PAI score > 1 and the presence of mucosal swelling in the maxillary sinus was detected (p = 0.03).

CONCLUSION

Periapical inflammation and maxillary mucositis could be visualized using STIR imaging. The use of MRI may help detect early, subtle inflammatory changes in the periapical tissues surrounding maxillary dentition. Early detection could guide diagnostic criteria, as well as treatment and prevention.

Sphenoid sinus mucosal thickening in patients with non-functioning pituitary adenoma

AIM

The aim of this study was to evaluate magnetic resonance imaging findings of sphenoid sinus (SS), pituitary gland and related structures in patients with non-functioning pituitary adenoma (NFPA) and compare to a control group.

METHODS

This study was conducted in a tertiary referral hospital between January 2018 and July 2020. Sixty-five patients diagnosed with NFPA and age- and gender-matched controls (n = 40) were included.

RESULTS

The average age in the NFPA group was 37.46 ± 11.2 years and in the control group was 41.97 ± 14.88 years, and they did not differ significantly (P = .103). SS mucosal thickness greater than 1 mm was determined in a higher proportion of NFPA (67.7%) than in the control group (12.5%) (P < .001). A mucosal thickness greater than 3 mm was only present in the NFPA group (43.1%). The distance between optic nerves was significantly longer in the NFPA group compared with control (P < .001). There was a strong positive correlation between adenoma volume and distance between the two optic nerves (r = .728, P < .001). Also, there was a moderate positive correlation between adenoma volume and petrous intercarotid distance (ICD) (r = .561, P < .001) and a low positive correlation between adenoma volume and cavernous ICD (r = .408, P < .001).

CONCLUSIONS

The present study showed an association between NFPA and both SS mucosal thickening and increased distance between optic nerves. Also, our study demonstrated that there was a strong positive correlation between adenoma volume and distance between the two optic nerves.

Pituitary Adenoma Apoplexy in an Adolescent: A Case Report and Review of the Literature

We present a 13-year-old boy who was admitted with complaints of a state of progressive sleepiness and a sudden headache with vomiting and fever. Laboratory testing showed hypoglycemia, multiple pituitary hormonal deficiencies, and an elevated C-reactive protein level. A cranial magnetic resonance imaging (MRI) showed an opaque sphenoid sinus and an intrasellar mass suggesting hemorrhage, so that we suspected pituitary apoplexy (PA) originating from a non-functioning adenoma, although a pituitary abscess could not completely be excluded. The boy was treated with antibiotics, hydrocortisone, and levothyroxine. Due to his rapid clinical improvement, no surgery was performed and we considered the diagnosis of PA as confirmed. At follow-up, the MRI scan showed a small residual lesion. Pituitary deficiencies of growth hormone, adrenocorticotropic hormone (ACTH), thyroid-stimulating hormone, and vasopressin persisted. A literature search of all well-documented cases of PA in children or adolescents (n=30, 13 boys and 17 girls) indicated that this condition is rare below 20 years of age but must be considered when a patient experiences headache with or without visual disturbances, even in the presence of clinical and laboratory signals suggestive of pituitary abscess. MRI neuroimaging is helpful in the differential diagnosis. In both conditions, the possibility of ACTH deficiency should always be considered, investigated, and treated. In cases without severe neuro-ophthalmological deficits and/or with a rapid and positive response to acute medical management, one can abstain from surgical treatment.

Sphenoid sinus mucosal thickening in the acute phase of pituitary apoplexy

PURPOSE

In pituitary apoplexy (PA), there are preliminary reports on the appearance of sphenoid sinus mucosal thickening (SSMT). SSMT is otherwise uncommon with an incidence of up to 7% in asymptomatic individuals. The aim of this study was to evaluate the incidence and clinical significance of SSMT in patients with PA and a control group of surgically treated non-functioning pituitary adenomas (NFPAs).

METHODS

Retrospective review of clinical and imaging variables in PA and NFPA patients. Sphenoid sinus mucosal thickness was measured on the presenting MRI scan by a blinded neuroradiologist. Pathological SSMT was defined as >1 mm adjacent to the pituitary fossa. Forward stepwise logistic regression was used to identify factors associated with SSMT.

RESULTS

There were 50 NFPA and 47 PA patients. PA patients were managed conservatively (N = 11) or surgically (N = 36). The median sphenoid sinus mucosal thickness was greater in the PA than NFPA groups (2.0 vs. 0.5 mm; p < 0.001). In multivariate analysis of both the PA and NFPA groups, the presence of PA was the only factor associated with SSMT (OR 0.043, 95% CI 0.012-0.16; p < 0.001). In multivariate analysis of the PA group alone, a shorter time from symptom onset to presenting MRI scan (OR 0.12, 95% CI 0.026-0.54; p = 0.006) and a more severe grade of apoplexy (OR 7.29, 95% CI 1.10-48.40; p = 0.04), were associated with SSMT.

CONCLUSION

The incidence of SSMT is higher in patients with PA, especially during the acute phase of PA. The aetiology of SSMT in PA is unclear and may reflect inflammatory and/or infective changes.

Assessment of nasal fibroscopy to explore olfactory cleft

OBJECTIVE

To assess whether flexible nasoendoscopy can be used to visualize all parts of the olfactory cleft (OC) without morbidity.

STUDY DESIGN

Single-center, prospective, observational study.

SETTING

French tertiary referral center.

SUBJECTS AND METHODS

100 consecutive patients were divided in 2 groups of 50. Group 1 underwent nasal fibroscopy without vasoconstriction or local anesthesia with an endosheath- protected endoscope. Group 2 was examined by a fiberscope without an endosheath after application of naphazoline Xylocaine. Each OC was divided in 16 items recorded as visualized or not. Four scores were compared between both groups: out of 16 (1 side), out of 32 (both sides), out of 12 concerning only the narrowest and highest bilateral spaces, and out of 4 to divide these specific areas in anterior, middle, and posterior parts. Length of procedure, pain, epistaxis, blood mark on the endosheath, sneezing, rhinorrhea, and causes of failure were recorded.

RESULTS

There was no significant difference between both groups concerning score out of 16 or 32. The visibility of the narrower and higher spaces was better in group 2: scores out of 12 were significantly different between the groups (P = .025), as were scores out of 4 for the anterior and middle parts of the OC (P = .02 and .01 respectively). Morbidity was low without differences between the groups. Deviated nasal septum was the only cause of failure and increased the patients' pain during the examination (P = .045).

CONCLUSION

Nasal fibroscopy could be used to explore the different portions of the OC efficiently and with low morbidity.

[Radiological diagnosis of the paranasal sinuses]

Although diseases of the paranasal sinuses have a relatively homogeneous clinical presentation, their causes can vary considerably. Radiological imaging only became relevant in paranasal sinus diagnostics following the introduction of cross-sectional imaging. In addition to technical details on imaging procedures and the individual criteria of the different modalities, anatomic details and congenital variations are presented. Particularly in acute inflammatory diseases as well as traumatic lesions, imaging is essential in preoperative planning and postoperative control. The article gives a detailed description of options in radiologic imaging of the paranasal sinuses.

Diagnostic and Staging Accuracy of Magnetic Resonance Imaging for the Assessment of Sinonasal Disease

Background

Concerns over radiation exposure with paranasal sinus computed tomography (CT) have recently evolved. Magnetic resonance imaging (MRI) may be more advantageous in this regard, but the diagnostic assessment of MRI in chronic rhinosinusitis (CRS) has not been reported. The purpose of this study was to determine the correlation between CT- and MRI-based staging and diagnosis of CRS.

Methods

Paired CT and MRI scans of 89 adult patients who were imaged by both modalities within a 3-month time period for evaluation of pituitary disease were scored for sinus disease using the Lund-Mackay system in a randomized and blinded fashion. The Lund scores were compared for similarity, correlation, and diagnostic classification between modalities.

Results

The mean Lund scores were 2.3 ± 0.6 (95% CI) for CT-based staging and 2.1 ± 0.5 for MRI-based staging with a median time interval between scans of 3 days. The difference means was not statistically significant (p = 0.444, paired t-test). Correlation analysis revealed a significant association between CT- and MRI-based scores (Pearson's r = 0.837, p < 0.001). Disease classification agreement analysis using published Lund score cutoffs (3 versus 4) for the likelihood of true sinus disease revealed that CT- and MRI-based scoring agreed on 76 cases (85.4%). Disagreement occurred in 13 cases (kappa: 0.557, p < 0.001). Sensitivity, specificity, positive predictive value, and negative predictive value were 66.7, 90.1, 63.2, and 91.4%, respectively.

Conclusion

Lund-Mackay staging of sinus disease by MRI is closely correlated to corresponding staging based on CT. MRI does not significantly overstage or overclassify patients with sinus disease.

Review of orbital imaging

CT and MRI are commonly used in the evaluation of patients with suspected orbital disease. Many different diseases may present within this small anatomical space. The purpose of this article is to present a diagnostic strategy based on a compartment model. Localizing pathology to sinus, bone, extraconal space, muscle cone, intraconal space, optic nerve, globe or lacrimal fossa allows significant reduction in the number of differential diagnoses as these compartments contain different tissues which disease may involve or arise from. Certain diseases may also present in multiple compartments. Common diseases which might present in one or multiple compartments will be discussed.

Radiological imaging of inflammatory lesions in the nasal cavity and paranasal sinuses

Paranasal sinus development and pneumatisation variants are described, and rhinosinusitis and different patterns of inflammatory sinonasal diseases are reviewed. Other inflammatory sinonasal diseases, e.g., fungal sinusitis, mucocele, pyocele and sinonasal manifestations in systemic diseases, are briefly described. Computed tomography (CT) is the primary modality in diagnosing and mapping suspected inflammatory sinonasal disease. Magnetic resonance (MR) imaging is complementary to CT if fungal sinusitis, pyocele or malignancy are suspected.

Prevalence of maxillary sinus disease and abnormalities in patients scheduled for sinus lift procedures

BACKGROUND

The purpose of the present study was to determine the prevalence of sinus disease and abnormalities among patients scheduled to undergo direct sinus augmentation.

METHODS

Forty-five patients attending a private periodontal practice and consecutively treatment planned for sinus augmentation were referred for otorhinolaryngologic evaluation, which included a medical history and radiographic (computed tomography), clinical, and endoscopic examinations. Pathological findings were recorded and otorhinolaryngologic treatment was provided. Six months later the sinus augmentation procedure was performed and followed by postoperative evaluations for 4 to 6 months.

RESULTS

Of the 45 subjects, 98% (44) were diagnosed with chronic periodontitis, 51% were smokers, and 27% reported a history of symptoms indicative of sinus disease. Eighteen subjects were diagnosed with sinus disease and/or abnormalities. The diagnosed conditions included chronic sinusitis, sinus cysts, nasal septum deviation, and ostium stenosis. No significant differences in age, gender, or smoking status between patients with and without sinus conditions were found (P >0.05). There was a significant association between history of symptoms and diagnosis of sinus conditions (P <0.0001). Three subjects (one treated for preoperative sinus conditions) experienced notable intra- or postoperative complications related to the sinus augmentation procedure.

CONCLUSIONS

The results indicate that, in a population of patients with chronic periodontitis, presence of sinus conditions is strongly associated with a history of indicative symptoms and is independent of age, gender, and smoking status. The results reinforce the importance of careful detailed history taking and thorough clinical and radiographic evaluation prior to performing sinus augmentation.

Radiographic, magnetic resonance imaging, computed tomographic, and rhinoscopic features of nasal aspergillosis in dogs

OBJECTIVE

To determine radiographic, magnetic resonance imaging (MRI), computed tomography (CT), and rhinoscopic features of nasal aspergillosis in dogs.

DESIGN

Prospective study.

ANIMALS

15 client-owned dogs.

PROCEDURE

All dogs had clinical signs of chronic nasal disease; the diagnosis of nasal aspergillosis was made on the basis of positive results for at least 2 diagnostic tests (serology, cytology, histology, or fungal culture) and detection of typical intrasinusal and intranasal fungal colonies and turbinate destruction via rhinoscopy. Radiography, MRI, and CT were performed under general anesthesia. Rhinoscopy was repeated to evaluate lesions and initiate treatment. Findings of radiography, MRI, CT, and rhinoscopy were compared.

RESULTS

MRI and CT revealed lesions suggestive of nasal aspergillosis more frequently than did radiography. Computed tomography was the best technique for detection of cortical bone lesions; the nature of abnormal soft tissue, however, could not be identified. Magnetic resonance imaging allowed evaluation of lesions of the frontal bone and was especially useful for differentiating between a thickened mucosa and secretions or fungal colonies; however, fungal colonies could not be differentiated from secretions. Rhinoscopy allowed identification of the nature of intranasal and intrasinusal soft tissue but was not as useful as CT and MRI for defining the extent of lesions and provided no information regarding bone lesions.

CONCLUSIONS AND CLINICAL RELEVANCE

The value of CT and MRI for diagnosis of nasal aspergillosis was similar and greater than that of radiography. Rhinoscopy is necessary because it is the only technique that allows direct visualization of fungal colonies.

Imaging of chemosensory loss

Clinical assessment of olfactory dysfunction can be challenging. Because olfactory disturbances comprise most chemosensory abnormalities with imaging findings, this article focuses on the imaging of smell disorders. This article reviews the normal imaging appearance of the olfactory apparatus, discusses the respective roles of CT and MRI, provides illustrative imaging of typical pathologic lesions, and discusses a clinically based imaging strategy.

MR imaging of nasopalatine duct cysts

We describe the magnetic resonance (MR) features of two cases of nasopalatine duct cyst (NPDC), including the first presentation of T1-weighted images (WI). The signal intensity of the cases of NPDC showed homogeneous high signal intensity on both on T1 and T2WI, although most cysts of maxillofacial regions demonstrate low to intermediate signal intensity on T1WI. NPDC may commonly be of high signal intensity on T1WI, which is consistent with keratin and viscous fluids.