Vascular complications include cavernous sinus thrombosis and rarely pseudoaneurysm formation [2,24]. Arteriography Craniofacial Arteriography may be performed for the evaluation of a pseudoaneurysm, although this would not be performed in the initial imaging evaluation. There is no relevant literature to support the use of arteriography in the evaluation of ARS with suspected orbital or intracranial complication. CT Cone Beam Paranasal Sinuses CBCT is not helpful in the imaging assessment of patients with ARS with suspected orbital or intracranial complications because of a limited evaluation of the soft-tissue structures [19,25]. CT Head CT maxillofacial is useful as the first-line CT examination for patients with ARS with suspected intraorbital and intracranial complications, because complications adjacent to the paranasal sinuses are typically included in the field of view. MRI is overall more useful than CT for the evaluation of intracranial complications, but because CT may be the first imaging study ordered, contrast-enhanced CT head may be added to the CT maxillofacial examination for increased coverage of a suspected intracranial complication. CT head with intravenous (IV) contrast can accurately identify clinically suspected intracranial complications including epidural abscess, subdural empyema, cerebritis, and brain abscess. The accuracy for the detection of intracranial complications has been reported to be 87% for CT, compared with 97% for MRI [23], although the detection of cavernous sinus thrombosis, meningitis, and early cerebritis is more difficult on CT compared with MRI [6,17,23]. There is no relevant literature to support the use of noncontrast CT head or combined pre- and postcontrast CT imaging. CT Maxillofacial CT of the paranasal sinuses with IV contrast can accurately confirm paranasal sinus inflammation and identify orbital complications and adjacent intracranial complications included in the field of view [17].
Sinonasal Disease. Vascular complications include cavernous sinus thrombosis and rarely pseudoaneurysm formation [2,24]. Arteriography Craniofacial Arteriography may be performed for the evaluation of a pseudoaneurysm, although this would not be performed in the initial imaging evaluation. There is no relevant literature to support the use of arteriography in the evaluation of ARS with suspected orbital or intracranial complication. CT Cone Beam Paranasal Sinuses CBCT is not helpful in the imaging assessment of patients with ARS with suspected orbital or intracranial complications because of a limited evaluation of the soft-tissue structures [19,25]. CT Head CT maxillofacial is useful as the first-line CT examination for patients with ARS with suspected intraorbital and intracranial complications, because complications adjacent to the paranasal sinuses are typically included in the field of view. MRI is overall more useful than CT for the evaluation of intracranial complications, but because CT may be the first imaging study ordered, contrast-enhanced CT head may be added to the CT maxillofacial examination for increased coverage of a suspected intracranial complication. CT head with intravenous (IV) contrast can accurately identify clinically suspected intracranial complications including epidural abscess, subdural empyema, cerebritis, and brain abscess. The accuracy for the detection of intracranial complications has been reported to be 87% for CT, compared with 97% for MRI [23], although the detection of cavernous sinus thrombosis, meningitis, and early cerebritis is more difficult on CT compared with MRI [6,17,23]. There is no relevant literature to support the use of noncontrast CT head or combined pre- and postcontrast CT imaging. CT Maxillofacial CT of the paranasal sinuses with IV contrast can accurately confirm paranasal sinus inflammation and identify orbital complications and adjacent intracranial complications included in the field of view [17].