The presence of 2 or more of these symptoms for >12 weeks is highly sensitive for the diagnosis of CRS, but because these symptoms are nonspecific, documentation of inflammation on endoscopy or imaging is required to confirm the diagnosis [26]. Imaging findings that confirm CRS include mucosal thickening, sinus opacification, polyps or retention cysts, and sclerosis and thickening of the sinus walls [2,26]. Studies have shown variable correlation between the imaging findings and clinical symptoms of CRS. The Lund- Mackay and modified Lund-Mackay system are the most commonly used imaging staging systems, with some studies showing good correlation with disease severity and surgical outcomes [2,27,28]. Some studies have not demonstrated a correlation between symptom severity and CT findings [29-31], although correlation may be higher in patients with associated nasal polyps [29]. Sinonasal Disease Functional endoscopic sinus surgery is now the standard of care for restoring patency of paranasal sinus outflow tracts, with postoperative improvement in symptoms and quality of life reported in over 75% of patients [32]. Functional endoscopic sinus surgery may be performed for CRS and other nonneoplastic indications including acute recurrent rhinosinusitis, noninvasive fungal sinusitis and fungus ball, sinonasal polyposis, silent sinus syndrome, mucocele, and deviated nasal septum. Imaging that provides anatomical detail is needed for surgical planning, in particular for the identification of anatomic variants and abnormalities that can increase the risk for intracranial, intraorbital, and vascular injury. Arteriography Craniofacial There is no relevant literature to support the use of arteriography in the evaluation of CRS or for presurgical planning of paranasal sinus inflammatory disease. CT Cone Beam Paranasal Sinuses CBCT has been shown to have high accuracy for evaluating odontogenic and nonodontogenic sinusitis, with strong agreement between CBCT and sinus endoscopy [33].
Sinonasal Disease. The presence of 2 or more of these symptoms for >12 weeks is highly sensitive for the diagnosis of CRS, but because these symptoms are nonspecific, documentation of inflammation on endoscopy or imaging is required to confirm the diagnosis [26]. Imaging findings that confirm CRS include mucosal thickening, sinus opacification, polyps or retention cysts, and sclerosis and thickening of the sinus walls [2,26]. Studies have shown variable correlation between the imaging findings and clinical symptoms of CRS. The Lund- Mackay and modified Lund-Mackay system are the most commonly used imaging staging systems, with some studies showing good correlation with disease severity and surgical outcomes [2,27,28]. Some studies have not demonstrated a correlation between symptom severity and CT findings [29-31], although correlation may be higher in patients with associated nasal polyps [29]. Sinonasal Disease Functional endoscopic sinus surgery is now the standard of care for restoring patency of paranasal sinus outflow tracts, with postoperative improvement in symptoms and quality of life reported in over 75% of patients [32]. Functional endoscopic sinus surgery may be performed for CRS and other nonneoplastic indications including acute recurrent rhinosinusitis, noninvasive fungal sinusitis and fungus ball, sinonasal polyposis, silent sinus syndrome, mucocele, and deviated nasal septum. Imaging that provides anatomical detail is needed for surgical planning, in particular for the identification of anatomic variants and abnormalities that can increase the risk for intracranial, intraorbital, and vascular injury. Arteriography Craniofacial There is no relevant literature to support the use of arteriography in the evaluation of CRS or for presurgical planning of paranasal sinus inflammatory disease. CT Cone Beam Paranasal Sinuses CBCT has been shown to have high accuracy for evaluating odontogenic and nonodontogenic sinusitis, with strong agreement between CBCT and sinus endoscopy [33].