Imaging for staging of rhinosinusitis

Although clinical judgment is sufficient to diagnose rhinosinusitis in many cases, a number of patients with recurrent or complicated sinus disease require imaging studies. Advances in the field of diagnostic imaging techniques such as computed x-ray tomography (CT) and magnetic resonance imaging have enhanced our understanding and management of the disease. Magnetic resonance imaging excels in displaying soft tissue resolution and is superior in demonstrating the presence of neoplasia and fungal sinusitis, but has limited advantages over CT scanning in demonstrating the regional anatomy (bony structure) and in the diagnosis of chronic rhinosinusitis. Computed tomography provides greater detailed information about the paranasal sinuses than do plain radiographic films. Rhinosinusitis staging systems utilizing CT techniques are reviewed. Although results from the Lund-Mackay system appear to be easily reproducible, there are still clinical challenges not addressed by this method of classification. Considering the patency of specific ostiomeatal channels and quantifying the volume of disease may add to the clinical value of future classification systems.