Radiographic evaluation for nasal dysfunction: Computed tomography versus plain films

Abstract

Sixty-two patients, presenting to the Nasal Dysfunction Clinic at the University of California, San Diego, were radiographically examined with plain sinus x-rays and computed tomographic (CT) scans. The x-rays were evaluated independently, and the reported findings were compared. In maxillary sinuses the CT and plain film observations corresponded poorly with a concordance of 77%. There was a tendency to overread the plain films. In the ethmoid sinuses the lack of concordance between CT scans and plain films was 76%, and a tendency to underread the plain films was noted. In the lower nasal compartment the correspondence between CT and plain film readings was 57%, with a notable tendency to overread the plain films. In the olfactory recess, the CT/plain film concordance was 66%. At our institution, a sinus CT series costs $400; a conventional sinus series costs $102. The CT radiation dose is 5.2 to 6.5 cGY compared with 1.4 cGY for plain films. We conclude that plain films are unreliable and no longer routinely indicated for the evaluation of nasal and paranasal sinus disease. When radiographic evaluation is indicated a limited CT series provides superior information. Exceptions may include children and some cases of sinus disease isolated to a single sinus.

Association Between Clinical Characteristics, Computed Tomography Characteristics, and Histologic Diagnosis for Cats With Sinonasal Disease

“…The most common nasal neoplasms were lymphoma (5) and squamous cell carcinoma (3). Other tumor types included nasal adenocarcinoma (2), poorly differentiated sarcoma (2), osteosarcoma (2), and undifferentiated carcinoma (1). All cats in the non-neoplasia group had rhinitis.…”

“…Radiography in the evaluation of the nasal cavity and paranasal sinuses has significant limitations because of superimposition of structures. [1][2][3] Furthermore, in dogs and cats radiographic features of nasal neoplasia are often indistinguishable from chronic rhinitis. [4][5][6][7][8] Radiographic opacification of the nasal cavities and paranasal sinuses, and osteolysis of turbinates, and/or paranasal bones can be seen with both conditions.…”

Recommendations for the management of cough in adults

“…78 However, sinus radiographs are less sensitive than CT imaging of the sinuses. 201 In a prospective study, routine CT sinus scanning was no better than an ENT examination in accurately identifying upper airway disease as a cause of the cough. 55…”

Computed Tomographic Evaluation of Anatomical Variants of Paranasal Sinuses in Sinusitis.

“…Both these two technological advances in imaging modalities provide greater detail and about the anatomic extent of disease. Plain radiography has limited value for imaging paranasal sinuses, especially the ethmoid sinuses and the ostiomeatal complex and its use is not indicated [4][5].…”