Although MRI is also more sensitive than CT in diagnosing the presence of osteomyelitis, it does not demonstrate the bony detail of the osteomeatal complex well and is less sensitive to bony erosions. MRI may require sedation or general anesthesia in order to be performed in young children [61]. Contrast-enhanced MRI evaluation can be helpful in delineating the presence and extent of suspected complications of sinusitis. The initial stages of fungal infection may not be apparent by imaging. MRI is more sensitive for detecting early changes of fungal sinusitis than CT. Perisinus invasion detected by MRI was found to be the most sensitive and specific single finding indicating invasive fungal sinusitis [70]. Radiography Paranasal Sinuses Radiography is not sensitive for the soft-tissue changes or intracranial complications related to invasive fungal sinusitis. Summary of Recommendations Variant 1: Child. Uncomplicated acute sinusitis: imaging studies are not recommended. Variant 2: Child. Persistent sinusitis (worsening course or severe presentation, or not responding to treatment), or recurrent sinusitis, or chronic sinusitis, or define paranasal sinus anatomy before functional endoscopic sinus surgery: CT of the paranasal sinuses without IV contrast is recommended. Variant 3: Child. Sinusitis with clinical concern of orbital or intracranial complications: CT or MRI of the head and paranasal sinuses with IV contrast is recommended. CTA or MRA/MRV may be complementary in cases with suspected vascular complications. Variant 4: Child. Suspected invasive fungal sinusitis: CT or MRI of the head and paranasal sinuses with IV contrast is recommended. CTA or MRA/MRV may be complementary in cases with suspected vascular complications. Although there are references that report on studies with design limitations, 15 well-designed or good-quality studies provide good evidence. Supporting Documents For additional information on the Appropriateness Criteria methodology and other supporting documents go to www.
Sinusitis Child. Although MRI is also more sensitive than CT in diagnosing the presence of osteomyelitis, it does not demonstrate the bony detail of the osteomeatal complex well and is less sensitive to bony erosions. MRI may require sedation or general anesthesia in order to be performed in young children [61]. Contrast-enhanced MRI evaluation can be helpful in delineating the presence and extent of suspected complications of sinusitis. The initial stages of fungal infection may not be apparent by imaging. MRI is more sensitive for detecting early changes of fungal sinusitis than CT. Perisinus invasion detected by MRI was found to be the most sensitive and specific single finding indicating invasive fungal sinusitis [70]. Radiography Paranasal Sinuses Radiography is not sensitive for the soft-tissue changes or intracranial complications related to invasive fungal sinusitis. Summary of Recommendations Variant 1: Child. Uncomplicated acute sinusitis: imaging studies are not recommended. Variant 2: Child. Persistent sinusitis (worsening course or severe presentation, or not responding to treatment), or recurrent sinusitis, or chronic sinusitis, or define paranasal sinus anatomy before functional endoscopic sinus surgery: CT of the paranasal sinuses without IV contrast is recommended. Variant 3: Child. Sinusitis with clinical concern of orbital or intracranial complications: CT or MRI of the head and paranasal sinuses with IV contrast is recommended. CTA or MRA/MRV may be complementary in cases with suspected vascular complications. Variant 4: Child. Suspected invasive fungal sinusitis: CT or MRI of the head and paranasal sinuses with IV contrast is recommended. CTA or MRA/MRV may be complementary in cases with suspected vascular complications. Although there are references that report on studies with design limitations, 15 well-designed or good-quality studies provide good evidence. Supporting Documents For additional information on the Appropriateness Criteria methodology and other supporting documents go to www.