Furthermore, MRI does not demonstrate the bony detail of the osteomeatal complex well and is less sensitive to bony erosions, making it less well suited than CT to evaluate for underlying anatomic abnormalities that may predispose to and from chronic sinusitis. Radiography Paranasal Sinuses Radiography is limited in the evaluation of persistent sinusitis because the views traditionally used in the evaluation of the paranasal sinuses are difficult to perform in young children and have low sensitivity and specificity for sinus disease as compared to CT because of a lack of anatomical detail [45-47,61-63]. The Water projection is the single best view for the evaluation of the maxillary antra. In patients with chronic sinusitis, the Water view reveals a sensitivity of 84.2% and specificity of 76.6% for the detection of sinus disease as compared to the gold standard of nasal endoscopy [16,17]. However, the Water view has also been shown to have a 32% false-negative rate and a 49.2% false-positive rate as compared to CT. In addition, most of the abnormalities in the ethmoid and sphenoid sinuses are not detected on the Water view [64]. The Caldwell and Water projections have also been shown to be limited in the detection of ethmoid disease [54]. Variant 3: Child. Sinusitis with clinical concern of orbital or intracranial complications. Initial imaging. Symptoms at presentation that suggest intracranial complications include Pott puffy tumor, altered consciousness, seizures, hemiparesis, and cranial nerve palsy [19-23]. Complications include meningitis, encephalitis, epidural and subdural suppuration, orbital abscess, and, less commonly, brain abscess and dural sinus thrombophlebitis [19-23]. Cross-sectional imaging should therefore include the paranasal sinuses and head. CT Head and Paranasal Sinuses Noncontrast CT examination utilizing the routine head CT or paranasal sinus CT protocol alone may not provide sufficient anatomical coverage for evaluation for complications.
Sinusitis Child. Furthermore, MRI does not demonstrate the bony detail of the osteomeatal complex well and is less sensitive to bony erosions, making it less well suited than CT to evaluate for underlying anatomic abnormalities that may predispose to and from chronic sinusitis. Radiography Paranasal Sinuses Radiography is limited in the evaluation of persistent sinusitis because the views traditionally used in the evaluation of the paranasal sinuses are difficult to perform in young children and have low sensitivity and specificity for sinus disease as compared to CT because of a lack of anatomical detail [45-47,61-63]. The Water projection is the single best view for the evaluation of the maxillary antra. In patients with chronic sinusitis, the Water view reveals a sensitivity of 84.2% and specificity of 76.6% for the detection of sinus disease as compared to the gold standard of nasal endoscopy [16,17]. However, the Water view has also been shown to have a 32% false-negative rate and a 49.2% false-positive rate as compared to CT. In addition, most of the abnormalities in the ethmoid and sphenoid sinuses are not detected on the Water view [64]. The Caldwell and Water projections have also been shown to be limited in the detection of ethmoid disease [54]. Variant 3: Child. Sinusitis with clinical concern of orbital or intracranial complications. Initial imaging. Symptoms at presentation that suggest intracranial complications include Pott puffy tumor, altered consciousness, seizures, hemiparesis, and cranial nerve palsy [19-23]. Complications include meningitis, encephalitis, epidural and subdural suppuration, orbital abscess, and, less commonly, brain abscess and dural sinus thrombophlebitis [19-23]. Cross-sectional imaging should therefore include the paranasal sinuses and head. CT Head and Paranasal Sinuses Noncontrast CT examination utilizing the routine head CT or paranasal sinus CT protocol alone may not provide sufficient anatomical coverage for evaluation for complications.