In a study from Korea evaluating 23 patients with acute invasive fungal rhinosinusitis, extrasinonasal extension was demonstrated in all cases on MRI, with orbital extension in 65%; lack of contrast enhancement was seen in 48% of patients and was found to be a prognostic factor for disease-specific mortality [46]. Although noncontrast imaging can demonstrate fluid collections and edema, combined pre- and postcontrast imaging provides the best opportunity to identify and characterize potential orbital, intracranial, and vascular complications. Sinonasal Disease Radiography Paranasal Sinuses Radiography of the paranasal sinuses is considered to be of limited usefulness given a large number of false-negative results [47]. Findings of bone erosion may be seen in advanced cases, but CT is more useful for the detection of bony erosion and adjacent soft-tissue involvement. SPECT or SPECT/CT Paranasal Sinuses There is no relevant literature to support the use of SPECT or SPECT/CT in the evaluation of acute invasive fungal sinusitis. Variant 5: Suspected sinonasal mass. Initial imaging. Patients with a sinonasal mass may present with nasal congestion, nasal fullness, anosmia, rhinorrhea, and epistaxis [8,9]. Benign lesions include papilloma, respiratory epithelial adenomatoid hamartoma, pleomorphic adenoma, juvenile nasopharyngeal angiofibroma, nerve sheath tumor, and meningioma [7,8]. The most common sinonasal malignancy is squamous cell carcinoma, with other malignancies including sinonasal undifferentiated carcinoma, adenocarcinoma, lymphoma, neuroendocrine tumors, salivary gland tumors, and melanoma [7,10]. A meningoencephalocele may also present as a sinonasal mass. Imaging may demonstrate specific features of a sinonasal mass, which can narrow a differential diagnosis and occasionally facilitate a specific diagnosis. Ultimately, very few imaging features are pathognomonic and most sinonasal neoplasms require histologic sampling for a specific diagnosis [7,24].
Sinonasal Disease. In a study from Korea evaluating 23 patients with acute invasive fungal rhinosinusitis, extrasinonasal extension was demonstrated in all cases on MRI, with orbital extension in 65%; lack of contrast enhancement was seen in 48% of patients and was found to be a prognostic factor for disease-specific mortality [46]. Although noncontrast imaging can demonstrate fluid collections and edema, combined pre- and postcontrast imaging provides the best opportunity to identify and characterize potential orbital, intracranial, and vascular complications. Sinonasal Disease Radiography Paranasal Sinuses Radiography of the paranasal sinuses is considered to be of limited usefulness given a large number of false-negative results [47]. Findings of bone erosion may be seen in advanced cases, but CT is more useful for the detection of bony erosion and adjacent soft-tissue involvement. SPECT or SPECT/CT Paranasal Sinuses There is no relevant literature to support the use of SPECT or SPECT/CT in the evaluation of acute invasive fungal sinusitis. Variant 5: Suspected sinonasal mass. Initial imaging. Patients with a sinonasal mass may present with nasal congestion, nasal fullness, anosmia, rhinorrhea, and epistaxis [8,9]. Benign lesions include papilloma, respiratory epithelial adenomatoid hamartoma, pleomorphic adenoma, juvenile nasopharyngeal angiofibroma, nerve sheath tumor, and meningioma [7,8]. The most common sinonasal malignancy is squamous cell carcinoma, with other malignancies including sinonasal undifferentiated carcinoma, adenocarcinoma, lymphoma, neuroendocrine tumors, salivary gland tumors, and melanoma [7,10]. A meningoencephalocele may also present as a sinonasal mass. Imaging may demonstrate specific features of a sinonasal mass, which can narrow a differential diagnosis and occasionally facilitate a specific diagnosis. Ultimately, very few imaging features are pathognomonic and most sinonasal neoplasms require histologic sampling for a specific diagnosis [7,24].