There is no relevant literature to support the use of noncontrast CT head or combined pre- and postcontrast CT imaging. CT Maxillofacial Noncontrast CT is effective in the evaluation of fungal sinusitis because it can demonstrate hyperattenuation in the involved sinus, bony erosions, and infiltration of the surrounding spaces [4,44]. Hyperattenuation within the paranasal sinuses can suggest the diagnosis but is nonspecific. Features including bone erosion and infiltration of the periantral fat have a high specificity but a limited sensitivity, particularly in the early phase of the disease, and severe predominantly unilateral nasal cavity mucosal thickening has a high sensitivity but low specificity [5,6,44]. In a retrospective study evaluating 42 patients with pathology-proven acute invasive fungal rhinosinusitis and 42 control patients from the same high-risk population, a 7-variable model was synthesized using infiltration of the periantral fat, pterygopalatine fossa, nasolacrimal duct and lacrimal sac, bone dehiscence, septal ulceration, and orbital involvement; positive findings in any 2 of the model variables demonstrated 88% sensitivity and 100% specificity [44]. Emphysematous soft tissue in the nasal cavity is also a specific sign of early invasive fungal sinusitis [5]. CT also enables surgical planning given its detailed depiction of sinonasal anatomy and can be used with surgical image-guidance systems when acquired with the appropriate protocol. CT with IV contrast may also be used to help demonstrate orbital and intracranial complications included in the field of view. [6,23,43]. There is no relevant literature to support the use of combined pre- and postcontrast CT imaging. CTA Head CTA head may be performed for the evaluation of vascular complications of invasive fungal sinusitis including pseudoaneurysm formation, thrombosis, and dissection, although this would not be performed in the initial imaging evaluation.
Sinonasal Disease. There is no relevant literature to support the use of noncontrast CT head or combined pre- and postcontrast CT imaging. CT Maxillofacial Noncontrast CT is effective in the evaluation of fungal sinusitis because it can demonstrate hyperattenuation in the involved sinus, bony erosions, and infiltration of the surrounding spaces [4,44]. Hyperattenuation within the paranasal sinuses can suggest the diagnosis but is nonspecific. Features including bone erosion and infiltration of the periantral fat have a high specificity but a limited sensitivity, particularly in the early phase of the disease, and severe predominantly unilateral nasal cavity mucosal thickening has a high sensitivity but low specificity [5,6,44]. In a retrospective study evaluating 42 patients with pathology-proven acute invasive fungal rhinosinusitis and 42 control patients from the same high-risk population, a 7-variable model was synthesized using infiltration of the periantral fat, pterygopalatine fossa, nasolacrimal duct and lacrimal sac, bone dehiscence, septal ulceration, and orbital involvement; positive findings in any 2 of the model variables demonstrated 88% sensitivity and 100% specificity [44]. Emphysematous soft tissue in the nasal cavity is also a specific sign of early invasive fungal sinusitis [5]. CT also enables surgical planning given its detailed depiction of sinonasal anatomy and can be used with surgical image-guidance systems when acquired with the appropriate protocol. CT with IV contrast may also be used to help demonstrate orbital and intracranial complications included in the field of view. [6,23,43]. There is no relevant literature to support the use of combined pre- and postcontrast CT imaging. CTA Head CTA head may be performed for the evaluation of vascular complications of invasive fungal sinusitis including pseudoaneurysm formation, thrombosis, and dissection, although this would not be performed in the initial imaging evaluation.