MRI Orbits, Face, and Neck As per clinical practice guidelines from the AAO-HNS, imaging is unnecessary for patients with a clinical diagnosis of ARS [1]. There is no relevant literature to support the use of MRI of the orbits, face, and neck in the evaluation of acute uncomplicated rhinosinusitis. Radiography Paranasal Sinuses As per clinical practice guidelines from the AAO-HNS, imaging of the sinuses is unnecessary for patients with a clinical diagnosis of ARS [1]. Radiography lacks specificity for the identification of ABRS, because sinus fluid can also be seen with viral upper respiratory tract infections [20]. Compared with CT, radiography has been shown to have a low sensitivity of 25% to 41% for all sinus groups except the maxillary sinuses with 80% sensitivity [21]. In a meta-analysis of 6 studies, radiographs of the paranasal sinuses demonstrated a sensitivity of 76% and specificity of 79% for the diagnosis of ABRS compared with sinus puncture [22]. SPECT or SPECT/CT Paranasal Sinuses There is no relevant literature to support the use of single-photon emission CT (SPECT) or SPECT/CT in the evaluation of acute uncomplicated rhinosinusitis. Variant 2: Acute rhinosinusitis with suspected orbital or intracranial complication. Initial imaging. ABRS may spread to the orbital and intracranial compartments through neurovascular foramina, areas of osseous erosion, or hematogenous spread along valveless veins [6]. Orbital complications are more common and include orbital cellulitis, subperiosteal abscess, and orbital abscess. Symptoms suggesting orbital involvement include eye swelling with or without proptosis, impaired eye movement, and decreased visual acuity [17,23]. Intracranial complications most commonly occur with frontal sinusitis and include epidural abscess, subdural empyema, cerebritis, brain abscess, and meningitis. Symptoms suggesting intracranial involvement include severe headache, photophobia, seizures, or other focal neurologic findings [6,17].
Sinonasal Disease. MRI Orbits, Face, and Neck As per clinical practice guidelines from the AAO-HNS, imaging is unnecessary for patients with a clinical diagnosis of ARS [1]. There is no relevant literature to support the use of MRI of the orbits, face, and neck in the evaluation of acute uncomplicated rhinosinusitis. Radiography Paranasal Sinuses As per clinical practice guidelines from the AAO-HNS, imaging of the sinuses is unnecessary for patients with a clinical diagnosis of ARS [1]. Radiography lacks specificity for the identification of ABRS, because sinus fluid can also be seen with viral upper respiratory tract infections [20]. Compared with CT, radiography has been shown to have a low sensitivity of 25% to 41% for all sinus groups except the maxillary sinuses with 80% sensitivity [21]. In a meta-analysis of 6 studies, radiographs of the paranasal sinuses demonstrated a sensitivity of 76% and specificity of 79% for the diagnosis of ABRS compared with sinus puncture [22]. SPECT or SPECT/CT Paranasal Sinuses There is no relevant literature to support the use of single-photon emission CT (SPECT) or SPECT/CT in the evaluation of acute uncomplicated rhinosinusitis. Variant 2: Acute rhinosinusitis with suspected orbital or intracranial complication. Initial imaging. ABRS may spread to the orbital and intracranial compartments through neurovascular foramina, areas of osseous erosion, or hematogenous spread along valveless veins [6]. Orbital complications are more common and include orbital cellulitis, subperiosteal abscess, and orbital abscess. Symptoms suggesting orbital involvement include eye swelling with or without proptosis, impaired eye movement, and decreased visual acuity [17,23]. Intracranial complications most commonly occur with frontal sinusitis and include epidural abscess, subdural empyema, cerebritis, brain abscess, and meningitis. Symptoms suggesting intracranial involvement include severe headache, photophobia, seizures, or other focal neurologic findings [6,17].