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Appropriateness Criteria

Reference Study Type Patients/Events Study Objective(Purpose of Study) Study Results Study Quality
1. Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, et al. Clinical practice guideline (update): Adult Sinusitis Executive Summary. Otolaryngol Head Neck Surg. 152(4):598-609, 2015 Apr. Review/Other-Dx N/A To assist in implementing the guideline recommendations, this article summarizes the rationale, purpose, and key action statements. The 14 developed recommendations address diagnostic accuracy for adult rhinosinusitis, the appropriate use of ancillary tests to confirm diagnosis and guide management (including radiography, nasal endoscopy, computed tomography, and testing for allergy and immune function), and the judicious use of systemic and topical therapy. Emphasis was also placed on identifying multiple chronic conditions that would modify management of rhinosinusitis, including asthma, cystic fibrosis, immunocompromised state, and ciliary dyskinesia. 4
2. Joshi VM, Sansi R. Imaging in Sinonasal Inflammatory Disease. [Review]. Neuroimaging Clin N Am. 25(4):549-68, 2015 Nov. Review/Other-Dx N/A To describe the four basic Sinusitis based on the duration of symptoms No results stated in the abstract. 4
3. Smith KA, Orlandi RR, Rudmik L. Cost of adult chronic rhinosinusitis: A systematic review. Laryngoscope 2015;125:1547-56. Review/Other-Tx N/A To summarize the literature evaluating the costs associated with the management of adult chronic rhinosinusitis (CRS) using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Forty-four studies were identified for inclusion. The range for overall CRS-related healthcare costs was $6.9 to $9.9 billion 2014 USD per year. Indirect costs were estimated as $13 billion 2014 USD per year. Annual medication costs prior to ESS ranged between $1,547 and $2,700 2014 USD per patient, with a uniform reduction in costs after ESS. The overall US cost of outpatient ESS ranged from $8,200 to $10,500 2014 USD per case. The overall annual economic burden of CRS in the United States was estimated to be $22 billion 2014 USD (direct and indirect costs). 4
4. Raz E, Win W, Hagiwara M, Lui YW, Cohen B, Fatterpekar GM. Fungal Sinusitis. [Review]. Neuroimaging Clin N Am. 25(4):569-76, 2015 Nov. Review/Other-Dx N/A To  explain the classification of fungal sinusitis, and then evaluates separately the different entities with a particular focus on the radiologic appearance, and the information that the clinician needs to know to institute an appropriate therapy No results stated in the abstract. 4
5. Ni Mhurchu E, Ospina J, Janjua AS, Shewchuk JR, Vertinsky AT. Fungal Rhinosinusitis: A Radiological Review With Intraoperative Correlation. [Review]. Can Assoc Radiol J. 68(2):178-186, 2017 May. Review/Other-Dx N/A To discuss the review of the Fungal Rhinosinusitis with Intraoperative Correlation. No results stated in the abstract. 4
6. Velayudhan V, Chaudhry ZA, Smoker WRK, Shinder R, Reede DL. Imaging of Intracranial and Orbital Complications of Sinusitis and Atypical Sinus Infection: What the Radiologist Needs to Know. [Review]. Curr Probl Diagn Radiol. 46(6):441-451, 2017 Nov - Dec. Review/Other-Dx N/A To review the imaging features of a spectrum of complications associated with acute sinusitis and atypical infections. No results stated in the abstract. 4
7. Koeller KK. Radiologic Features of Sinonasal Tumors. [Review]. Head Neck Pathol. 10(1):1-12, 2016 Mar. Review/Other-Dx N/A To emphasize the essential imaging manifestations that correlate with sinonasal tumors in general and highlight certain features that may implicate a specific disease process. No results stated in the abstract. 4
8. Tatekawa H, Shimono T, Ohsawa M, Doishita S, Sakamoto S, Miki Y. Imaging features of benign mass lesions in the nasal cavity and paranasal sinuses according to the 2017 WHO classification. [Review]. Jpn J Radiol. 36(6):361-381, 2018 Jun. Review/Other-Dx N/A To describe the clinical characteristics and imaging features of each of clinically important nasal and paranasal benign mass lesions, as classified according to the WHO 2017 classification of head and neck tumors, along with some inflammatory diseases. No results stated in the abstract 4
9. Peckham ME, Wiggins RH 3rd, Orlandi RR, Anzai Y, Finke W, Harnsberger HR. Intranasal Esthesioneuroblastoma: CT Patterns Aid in Preventing Routine Nasal Polypectomy. AJNR Am J Neuroradiol. 39(2):344-349, 2018 Feb. Observational-Dx 30 patients To review histologically proved cases of intranasal esthesioneuroblastoma. Eight histologically proved cases of intranasal esthesioneuroblastoma were reviewed. All cases had CT demonstrating 3 main findings: 1) an intranasal polypoid lesion with its epicenter in a unilateral olfactory recess, 2) causing asymmetric olfactory recess widening, and 3) extending to the cribriform plate. Twelve patients with non-esthesioneuroblastoma diseases involving the olfactory recess were used as controls. Using these 3 esthesioneuroblastoma CT criteria, 2 blinded readers evaluating patients with esthesioneuroblastoma and controls had good diagnostic accuracy (area under the curve = 0.85 for reader one, 0.81 for reader 2) for predicting esthesioneuroblastoma. 1
10. Betts AM, Cornelius R. Magnetic resonance imaging in sinonasal disease. Top Magn Reson Imaging. 24(1):15-22, 2015 Feb. Review/Other-Dx N/A To discuss magnetic resonance imaging in sinonasal disease No results stated in the abstract. 4
11. Lloyd KM, DelGaudio JM, Hudgins PA. Imaging of skull base cerebrospinal fluid leaks in adults. [Review] [48 refs]. Radiology. 248(3):725-36, 2008 Sep. Review/Other-Dx N/A N/A No results stated in abstract. 4
12. Reddy M, Baugnon K. Imaging of Cerebrospinal Fluid Rhinorrhea and Otorrhea. [Review]. Radiol Clin North Am. 55(1):167-187, 2017 Jan. Review/Other-Dx N/A To  reviews the causes of cerebrospinal fluid (CSF) leaks, describes the methodology used to work up a suspected leak, and discusses the challenges of making an accurate diagnosis. No results state din the abstract. 4
13. Oakley GM, Alt JA, Schlosser RJ, Harvey RJ, Orlandi RR. Diagnosis of cerebrospinal fluid rhinorrhea: an evidence-based review with recommendations. [Review]. Int Forum Allergy Rhinol. 6(1):8-16, 2016 Jan. Review/Other-Dx 68 studies To discuss the diagnosis of cerebrospinal fluid rhinorrhea: an evidence-based review with recommendations. We reviewed 68 studies examining 9 practices pertinent to the diagnosis of CSF rhinorrhea, with a highest aggregate grade of evidence of C. The literature does not support the use of the ring sign, glucose testing, radionuclide cisternography (RNC), or computed tomography cisternography (CTC) for identification of CSF leak. Beta-2 transferrin is the most reliable confirmatory test for CSF leak. High-resolution CT (HRCT) is then recommended as the first-line study for localization. Magnetic resonance cisternography (MRC) should be used for CSF leak identification as a second line for each of these if beta-2 transferrin is not available or if HRCT is ambiguous. Intrathecal fluorescein (IF) may also be of benefit in certain clinical scenarios. 4
14. Xie T, Sun W, Zhang X, et al. The value of 3D-FIESTA MRI in detecting non-iatrogenic cerebrospinal fluid rhinorrhoea: correlations with endoscopic endonasal surgery. Acta Neurochir (Wien). 158(12):2333-2339, 2016 12. Observational-Dx 17 patients - To investigate the value of three-dimensional (3D) fast-imaging employing steady-state acquisition (FIESTA) magnetic resonance imaging (MRI) in detecting non-iatrogenic cerebrospinal fluid (CSF) rhinorrhoea and compared it with regular MRI and 3D magnetisation prepared rapid acquisition gradient echo (MPRAGE) MRI sequences, as well as high-resolution computed tomography (HRCT) imaging. - To present the endoscopic experiences of such cases. The sensitivities of the HRCT, regular MRI (T1 and T2), 3D-MPRAGE and 3D-FIESTA modalities for identifying CSF leakage were 58.8 %, (11.8 % and 29.4 %), 74.7 %, and 88.2 %, respectively. The origins of the leakages included the cribriform plate (18 %), ethmoidal fovea (23 %), lateral recess of the sphenoid (17 %), sellar floor (12 %), ethmoidal roof (12 %), junction of the fovea and cribriform plate (6 %) and the junction of sellar and sphenoidal planum (6 %). Two patients required repair. The first was under local anaesthesia when the nasal packing was removed, and the second underwent repair at the same site a half-year later due to hydrocephalus. Lumbar drainage was performed in all cases. No major complications were encountered. 2
15. Tekes A, Palasis S, Durand DJ, et al. ACR Appropriateness Criteria® Sinusitis-Child. J Am Coll Radiol 2018;15:S403-S12. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for sinusitis child. No results stated in abstract. 4
16. Aring AM, Chan MM. Current Concepts in Adult Acute Rhinosinusitis. [Review]. American Family Physician. 94(2):97-105, 2016 Jul 15. Review/Other-Dx N/A To discuss the current concepts in Adult Acute Rhinosinusitis. No results state din the abstract. 4
17. Dankbaar JW, van Bemmel AJ, Pameijer FA. Imaging findings of the orbital and intracranial complications of acute bacterial rhinosinusitis. Insights Imaging. 2015;6(5):509-518. Review/Other-Dx N/A To illustrate the anatomic relationship between the paranasal sinuses and the orbital and intracranial compartments. * Acute bacterial rhinosinusitis can cause severe orbital and intracranial complications. * If orbital or intracranial complications are suspected, cross-sectional imaging is mandatory. * Infection can spread from the ethmoid sinus to the orbit through the lamina papyracea. * Frontal sinusitis can spread intracranially through dehiscences or osteomyelitis. * Radiologists must recognize imaging findings of complications of acute bacterial rhinosinusitis. 4
18. Gwaltney JM, Jr., Phillips CD, Miller RD, Riker DK. Computed tomographic study of the common cold. N Engl J Med 1994;330:25-30. Observational-Dx 31 subjects had complete evaluations, 79 subjects underwent the same evaluations except CT To define abnormalities caused by cold in the nasal passages and sinus cavities with CT scan. Common cold is linked with frequent and variable anatomical involvement of the upper airways, including occlusion and abnormalities in the sinus cavities. 3
19. Al Abduwani J, ZilinSkiene L, Colley S, Ahmed S. Cone beam CT paranasal sinuses versus standard multidetector and low dose multidetector CT studies. Am J Otolaryngol. 2016;37(1):59-64. Observational-Dx 21 patients To compare the absorbed dose of radiation from CBCT and conventional CT, and to compare the clarity and image quality for important structures in sinus anatomy in patients with sinus disease meriting CT scan imaging. The mean effective dose of twenty one consecutive CBCTs of paranasal sinuses performed in our institution over a one year period was 0.27 mSv (range 0.05-0.48 mSv). The dose was approximately 40% lower when compared to a similar cohort of standard MDCT examinations and 30% lower when compared to low dose sinus CT scans. The visualization of high-contrast bone morphology on CBCT was comparable to standard sinus CT, allowing clear delineation of the principal surgically relevant osseous structures. Soft tissue visibility was however limited. 3
20. Ebell MH, McKay B, Guilbault R, Ermias Y. Diagnosis of acute rhinosinusitis in primary care: a systematic review of test accuracy. [Review]. Br J Gen Pract. 66(650):e612-32, 2016 Sep. Review/Other-Dx 30 studies(24 patients) To determine the accuracy of laboratory and imaging studies for the diagnosis of Acute rhinosinusitis (ARS) Using antral puncture as the reference standard, A mode ultrasound (positive likelihood ratio [LR+] 1.71, negative likelihood ratio [LR-] 0.41), B mode ultrasound (LR+ 1.64, LR- 0.69), and radiography (LR+ 2.01, LR- 0.28) had only modest accuracy. Accuracy was higher using imaging as the reference standard for both ultrasound (LR+12.4, LR- 0.35) and radiography (LR+ 9.4, LR- 0.27), although this likely overestimates accuracy. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) both had clear threshold effects, and modest overall accuracy. The LR+ for ESR >30 and >40 were 4.08 and 7.40, respectively. A dipstick of nasal secretions for leucocyte esterase was highly accurate (LR+ 18.4, LR- 0.17) but has not been validated. 4
21. Aalokken TM, Hagtvedt T, Dalen I, Kolbenstvedt A. Conventional sinus radiography compared with CT in the diagnosis of acute sinusitis. Dentomaxillofac Radiol 2003;32:60-2. Observational-Dx 47 consecutive patients Prospective study to evaluate the accuracy of radiography in patients with clinical suspicion of acute sinusitis, using standard CT as a gold standard. Specificity of radiographic examination was high, but sensitivity was low except for the maxillary sinus (sensitivity 80%). The sensitivity of radiography for detecting sinus opacifications was unacceptably low for the ethmoid, frontal and sphenoid sinuses. 2
22. Lau J, Zucker D, Engels EA, Balk E, et al. Diagnosis and treatment of acute bacterial rhinosinusitis. Evidence Report/Technology Assessment No. 9 (Contract 290-97-0019 to the New England Medical Center). Rockville, MD: Agency for Health Care Policy and Research; March 1999. Review/Other-Dx N/A To discuss the Evidence Report/Technology and  assessment of the diagnosis and treatment of acute bacterial rhinosinusitis. No results stated in the abstract 4
23. Younis RT, Anand VK, Davidson B. The role of computed tomography and magnetic resonance imaging in patients with sinusitis with complications. Laryngoscope 2002;112:224-9. Observational-Dx 82 adult and pediatric patients Retrospective review comparing the role of CT with MRI in patients with sinusitis with complications. For patients with orbital complications, the diagnostic accuracy was 82% for clinical assessment compared with 91% for CT. For patients with intracranial complications, meningitis was common diagnosis and MRI was more accurate (97%) in determining diagnoses than CT (87%) or clinical findings (82%). 3
24. Pulickal GG, Navaratnam AV, Nguyen T, Dragan AD, Dziedzic M, Lingam RK. Imaging Sinonasal disease with MRI: Providing insight over and above CT. [Review]. Eur J Radiol. 102:157-168, 2018 May. Review/Other-Dx N/A To  illustrate and discuss the applications and value of magnetic resonance imaging (MRI) in the evaluation of sinonasal disease. No results stated in the abstract. 4
25. Fakhran S, Alhilali L, Sreedher G, et al. Comparison of simulated cone beam computed tomography to conventional helical computed tomography for imaging of rhinosinusitis. Laryngoscope 2014;124:2002-6. Observational-Dx 361 patients To determine how often clinically important findings would be missed if CBCT was used routinely for sinus imaging. Maxillofacial CTs from 361 consecutive patients were included, of which 12 (3.3%) demonstrated findings that would have been missed on the theoretical CBCT. Of those, four (1.1%) would have resulted in a change in management. Effective radiation dose for our scanners ranged from 0.67 mSv to 2.15 mSv, compared to a published estimated dose of 0.2 mSV for CBCT. 3
26. Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, et al. Clinical practice guideline (update): adult sinusitis. Otolaryngol Head Neck Surg. 152(2 Suppl):S1-S39, 2015 Apr. Review/Other-Tx N/A This guideline provides evidence-based recommendations on managing sinusitis. The panel made strong recommendations that 1) clinicians should distinguish presumed acute bacterial rhinosinusitis (ABRS) from acute rhinosinusitis caused by viral upper respiratory infections and noninfectious conditions, and a clinician should diagnose ABRS when (a) symptoms or signs of acute rhinosinusitis are present 10 days or more beyond the onset of upper respiratory symptoms, or (b) symptoms or signs of acute rhinosinusitis worsen within 10 days after an initial improvement (double worsening), and 2) the management of ABRS should include an assessment of pain, with analgesic treatment based on the severity of pain. The panel made a recommendation against radiographic imaging for patients who meet diagnostic criteria for acute rhinosinusitis, unless a complication or alternative diagnosis is suspected. The panel made recommendations that 1) if a decision is made to treat ABRS with an antibiotic agent, the clinician should prescribe amoxicillin as first-line therapy for most adults, 2) if the patient worsens or fails to improve with the initial management option by 7 days, the clinician should reassess the patient to confirm ABRS, exclude other causes of illness, and detect complications, 3) clinicians should distinguish chronic rhinosinusitis (CRS) and recurrent acute rhinosinusitis from isolated episodes of ABRS and other causes of sinonasal symptoms, 4) clinicians should assess the patient with CRS or recurrent acute rhinosinusitis for factors that modify management, such as allergic rhinitis, cystic fibrosis, immunocompromised state, ciliary dyskinesia, and anatomic variation, 5) the clinician should corroborate a diagnosis and/or investigate for underlying causes of CRS and recurrent acute rhinosinusitis, 6) the clinician should obtain computed tomography of the paranasal sinuses in diagnosing or evaluating a patient with CRS or recurrent acute rhinosinusitis, and 7) clinicians should educate/counsel patients with CRS or recurrent acute rhinosinusitis regarding control measures. The panel offered as options that 1) clinicians may prescribe symptomatic relief in managing viral rhinosinusitis, 2) clinicians may prescribe symptomatic relief in managing ABRS, 3) observation without use of antibiotics is an option for selected adults with uncomplicated ABRS who have mild illness (mild pain and temperature <38.3 degrees C or 101 degrees F) and assurance of follow-up, 4) the clinician may obtain nasal endoscopy in diagnosing or evaluating a patient with CRS or recurrent acute rhinosinusitis, and 5) the clinician may obtain testing for allergy and immune function in evaluating a patient with CRS or recurrent acute rhinosinusitis. 4
27. Brooks SG, Trope M, Blasetti M, et al. Preoperative Lund-Mackay computed tomography score is associated with preoperative symptom severity and predicts quality-of-life outcome trajectories after sinus surgery. Int Forum Allergy Rhinol. 8(6):668-675, 2018 06. Observational-Dx 665 patients To investigate whether preoperative Lund-Mackay CT scores (LMCTS) are associated with preoperative quality-of-life outcome (QoL), and whether LMCTS is predictive of postoperative QoL outcomes in chronic rhinosinusitis (CRS) patients. Preoperative LMCTS were significantly associated with preoperative SNOT-22 scores (p < 0.01) and postoperative SNOT-22 scores (p < 0.001), driven by Extranasal and Rhinologic subdomains of the QoL questionaire. Patients in the lowest preoperative LMCTS quartile had the lowest mean change in SNOT-22 scores at 12 months (16.8 points; 95% confidence interval [CI], 12.2-21.3). Patients in the second and third lowest preoperative LMCTS quartiles had mean changes at 12 months of 21.1 points (95% CI, 16.7-25.4) and 23.1 points (95% CI, 18.3-27.9). Patients in the highest preoperative LMCTS quartile had the greatest improvement in SNOT-22 scores after FESS (29.9 points; 95% CI, 24.9-34.8). The difference in QoL change at 12 months between the highest and lowest preoperative LMCTS quartiles was 13.1 points (95% CI, 6.0-20.2; p < 0.001). 2
28. Garneau J, Ramirez M, Armato SG 3rd, et al. Computer-assisted staging of chronic rhinosinusitis correlates with symptoms. Int Forum Allergy Rhinol. 5(7):637-642, 2015 Jul. Observational-Dx 55 patients To develop a "Modified Lund Mackay" (MLM) system, which uses a three-dimensional (3D), computerized method to quantify the volume of mucosal inflammation in the sinuses, and sought to determine whether the MLM would correlate with symptoms and disease-specific quality of life. Adjusting for age, gender, and smoking, a higher symptom burden was associated with increased sinonasal inflammation as captured by the MLM (ß = 0.453, p < 0.013). As expected due to the differences in scales, the LM and MLM scores were significantly different (p < 0.011). No association between MLM and SNOT-22 scores was found. 2
29. Greguric T, Trkulja V, Baudoin T, Grgic MV, Smigovec I, Kalogjera L. Association between computed tomography findings and clinical symptoms in chronic rhinosinusitis with and without nasal polyps. Eur Arch Otorhinolaryngol. 274(5):2165-2173, 2017 May. Observational-Dx 271 patients To test whether there is a difference between chronic rhinosinusitis patients with (CRSwNP) and without (CRSsNP) nasal polyps in the association of extent of disease on CT scans with symptom severity and health-related quality-of-life (HRQL) impairment. Data sets from 271 chronic rhinosinusitis (CRS) patients who completed the Sino-Nasal Outcome Test 22 (SNOT-22) and visual analog scale (VAS) scores were subjected to principal component analysis (PCA) to identify a symptom components related to CRS. After controlling for demographics, medical therapy, and comorbidities, the association between symptom components/items excluded from PCA and Lund-Mackay score (LMS) was evaluated. No association was found between the total SNOT-22 score and LMS in CRS patients. There was an independent association between a higher "nasal" symptom component derived from SNOT-22 PCA and LMS in patients with CRSwNP (p < 0.001), but not in CRSsNP patients, with a statistically significant difference between two patient subsets (p = 0.003). In patients with CRSsNP, higher (worse) SNOT-22 "facial pain" was associated with lower LMS (p = 0.022), although the estimated change in LMS was modest. Considering VAS PCA components, higher "nasal" symptoms were associated with higher LMS in CRSwNP patients (p < 0.001) but not in CRSsNP, with a statistically significant difference between CRS groups (p = 0.024). A higher "pain" PCA component was associated with lower LMS in CRSsNP patients (p = 0.019). This study found significant differences in the relationship between symptom burden and CT scores between CRS phenotypes and no association between HRQL impairment and CT scores. 2
30. Falco JJ, Thomas AJ, Quin X, et al. Lack of correlation between patient reported location and severity of facial pain and radiographic burden of disease in chronic rhinosinusitis. Int Forum Allergy Rhinol. 6(11):1173-1181, 2016 11. Observational-Dx 83 patients To measure pain location, severity, and interference in patients with CRS, and correlate these to the location and severity of radiographic evidence of disease. Consecutive patients with CRS with nasal polyps (CRSwNP; n = 37) and CRS without nasal polyps (CRSsNP; n = 46) were enrolled. No significant relationship was found between the location and severity of reported facial pain and radiographic findings of disease for patients with either CRSwNP or CRSsNP. There was no difference in pain location between patients with and without radiographic disease in a given sinus. 2
31. Shpilberg KA, Daniel SC, Doshi AH, Lawson W, Som PM. CT of Anatomic Variants of the Paranasal Sinuses and Nasal Cavity: Poor Correlation With Radiologically Significant Rhinosinusitis but Importance in Surgical Planning. AJR 2015;204:1255-60. Review/Other-Dx 192 sinus CT examinations To determine the incidence of sinonasal anatomic variants and to assess their relation to sinonasal mucosal disease. The most common normal variants were nasal septal deviation, Agger nasi cells, and extension of the sphenoid sinuses into the posterior nasal septum. We found no statistically significant difference in the prevalence of any of the studied anatomic variants between patients with minimal and those with clinically significant paranasal sinus or nasal cavity disease. 4
32. O'Brien WT Sr, Hamelin S, Weitzel EK. The Preoperative Sinus CT: Avoiding a "CLOSE" Call with Surgical Complications. [Review]. Radiology. 281(1):10-21, 2016 Oct. Review/Other-Dx N/A To illustrate important anatomic variants and landmarks on the preoperative sinus CT with a focus on those that predispose patients to surgical complications. No results stated in the abstract. 4
33. Zojaji R, Naghibzadeh M, Mazloum Farsi Baf M, Nekooei S, Bataghva B, Noorbakhsh S. Diagnostic accuracy of cone-beam computed tomography in the evaluation of chronic rhinosinusitis. ORL J Otorhinolaryngol Relat Spec. 77(1):55-60, 2015. Observational-Dx 42 patients To assess the agreement of cone-beam computed tomography (CBCT) scan and sinus endoscopy findings and attempted to find a diagnostic accuracy of CBCT in patients with chronic rhinosinusitis (CRS). In most of our findings, except for infundibulum thickening, there was a strong agreement between CBCT and paranasal sinus endoscopy, with a kappa coefficient >0.80 (p < 0.05). The sensitivity, specificity, PPV, NPV, and accuracy of CBCT were >80% for most of the findings, except for infundibulum thickening and septal deviation. 2
34. Yamauchi T, Tani A, Yokoyama S, Ogawa H. Assessment of non-invasive chronic fungal rhinosinusitis by cone beam CT: comparison with multidetector CT findings. Fukushima J Med Sci. 63(2):100-105, 2017 Aug 09. Observational-Dx 38 patients To investigate the accuracy of cone beam CT (CBCT) to diagnose non-invasive chronic fungal rhinosinusitis. Detection of intrasinus calcification in patients with non-invasive chronic fungal maxillary sinusitis was higher in the MDCT group (84.2%) than the CBCT group (46.2%). 2
35. Fraczek M, Guzinski M, Morawska-Kochman M, Krecicki T. Investigation of sinonasal anatomy via low-dose multidetector CT examination in chronic rhinosinusitis patients with higher risk for perioperative complications. Eur Arch Otorhinolaryngol. 274(2):787-793, 2017 Feb. Observational-Dx 135 patients To compare visualisation of the surgically relevant anatomical structures via low- and standard-dose multidetector CT protocol in patients with chronic rhinosinusitis (CRS) and higher risk for perioperative complications (i.e. presence of bronchial asthma, history of sinus surgery and advanced nasal polyposis). 135 adult CRS patients were divided randomly into standard-dose (120 kVp, 100 mAs) or low-dose CT groups (120 kVp, 45 mAs). The detectability of the vital anatomical structures (anterior ethmoid artery, optic nerve, cribriform plate and lamina papyracea) was scored using a five-point scale (from excellent to unacceptable) by a radiologist and sinus surgeon. Polyp sizes were quantified endoscopically according to the Lildholdt's scale (LS). Olfactory function was tested with the "Sniffin' Sticks" test. On the low-dose CT images, detectability ranged from 2.42 (better than poor) for cribriform plate among anosmic cases to 4.11 (better than good) for lamina papyracea in cases without nasal polyps. Identification of lamina papyracea on low-dose scans was significantly worse in each group and the same was the case with cribriform plates in patients with advanced polyposis and anosmia. Cribriform plates were the most poorly identified (between poor and average) among all the structures on low-dose images. Identification of anterior ethmoid artery (AEA) with reduced dose was insignificantly worse than with standard-dose examination. The AEA was scored as an average-defined structure and was the second weakest visualised. In conclusion, preoperatively, low-dose protocols may not sufficiently visualise the surgically relevant anatomical structures in patients with CRS and bronchial asthma, advanced nasal polyps (LS > 2) and history of sinus surgery. Low mAs value enables comparable detectability of sinonasal landmarks with standard-dose protocols in patients without analysed risk factors. In the context of planned surgery, the current preferences of the tube should be carefully evaluated for different patient constitutions to minimise the risk of complications. 1
36. Sharma GK, Foulad A, Shamouelian D, Bhandarkar ND. Inefficiencies in Computed Tomography Sinus Imaging for Management of Sinonasal Disease. Otolaryngol Head Neck Surg. 156(3):575-582, 2017 03. Review/Other-Dx 183 patients To determine the frequencies of diagnostic CT sinus studies that were inadequate for image-guided sinus surgery (IGSS) and repeat CT studies for purposes of IGSS Seventy-one patients met indications for IGSS, of which 37 (52%) required repeat CT due to an IGSS-inadequate diagnostic scan. Conclusion The frequency of repeat preoperative CT sinus imaging may be high at tertiary care centers where IGSS is performed. A standardized IGSS-adequate CT sinus protocol may avoid the need for repeat preoperative scans. Potential advantages include improved efficiency, decreased health care costs, and reduced ionizing radiation exposure to the patient. 4
37. Eyigor H, Cekic B, Turgut Coban D, et al. Is there a correlation between the clinical findings and the radiological findings in chronic maxillary sinus atelectasis?. J Craniomaxillofac Surg. 44(7):820-6, 2016 Jul. Observational-Dx 16 patients To investigate the correlation between radiological findings and clinical findings in patients with radiologically asymmetrical reduced maxillary sinus volume. The study included 16 patients. Although a statistically significant difference was determined between the healthy and the pathological sides in respect to maxillary sinus volume, thickness of the retroantral fat tissue, infraorbital bone curve, uncinate process lateralisation measurement, and middle concha diameter (p = 0.00, p = 0.002, p = 0.020, p = 0.020, p = 0.007), no significant difference was determined in respect to the change in location of the inferior rectus muscle (p = 0.154). A positive correlation was determined between the increase in sulcus depth and maxillary sinus volume and inferior orbital bone curve (p < 0.05). 2
38. Sedaghat AR, Kieff DA, Bergmark RW, Cunnane ME, Busaba NY. Radiographic evaluation of nasal septal deviation from computed tomography correlates poorly with physical exam findings. Int Forum Allergy Rhinol. 5(3):258-62, 2015 Mar. Observational-Dx 39 patients To discuss whether radiographic evaluation of nasal septal deviation from computed tomography correlates poorly with physical exam findings Statistically significant correlation was detected between physical examination including nasal endoscopy and radiographic assessment of septal deviation only at the osseous septum (p = 0.007, r = 0.425) with low quantitative agreement (a = 0.290). No significant correlation was detected at the cartilaginous septum (p = 0.286, r = 0.175), inferior septum (p = 0.117, r = 0.255), or nasal valve (p = 0.174, r = 0.222). Quantitative agreement at the nasal valve suggested a bias in CT to underestimate physical exam findings (a = -0.490). 2
39. Dillon WP, Som PM, Fullerton GD. Hypointense MR signal in chronically inspissated sinonasal secretions. Radiology 1990;174:73-8. Review/Other-Dx 6 Patients To examine chronically obstructed sinuses with computed tomography (CT) and magnetic resonance (MR) imaging prior to surgical decompression. In all six patients, hypointense signal was present on all MR sequences despite CT evidence of the presence of high-attenuation material filling the sinus. At surgery, all specimens were viscid or pastelike with no evidence of hemorrhagic products as a cause for the MR findings. 4
40. Lin HW, Bhattacharyya N. Diagnostic and staging accuracy of magnetic resonance imaging for the assessment of sinonasal disease. Am J Rhinol Allergy 2009;23:36-9. Observational-Dx 89 patients Randomized blinded study to determine the correlation between CT- and MRI-based staging and diagnosis of CRS. The mean Lund scores were 2.3 +/- 0.6 (95% CI) for CT-based staging and 2.1 +/- 0.5 for MRI-based staging with a median time interval between scans of 3 days. The difference means was not statistically significant (P=0.444, paired t-test). Correlation analysis revealed a significant association between CT- and MRI-based scores (Pearson’s r = 0.837, P<0.001). Disease classification agreement analysis using published Lund score cutoffs (3 vs 4) for the likelihood of true sinus disease revealed that CT- and MRI-based scoring agreed on 76 cases (85.4%). Disagreement occurred in 13 cases (kappa: 0.557, P<0.001). Sensitivity, specificity, PPV, and NPV were 66.7%, 90.1%, 63.2%, and 91.4%, respectively. Lund-Mackay staging of sinus disease by MRI is closely correlated to corresponding staging based on CT. MRI does not significantly overstage or overclassify patients with sinus disease. 2
41. Yousem DM. Imaging of sinonasal inflammatory disease. Radiology. 1993;188(2):303-314. Review/Other-Dx N/A To review anatomy of the sinonasal cavity, imaging of uncomplicated and complicated sinusitis, and analyze the current role of each imaging modality. Changes in imaging sinonasal inflammatory disease have paralleled changes in the treatment of chronic sinusitis. As functional endoscopic sinus surgery has become a more widespread technique, coronal computed tomography (CT) has become the primary imaging modality, replacing plain radiography. Knowledge of the plethora of sinonasal anatomic variations and the inherent surgical implications is critical to the interpretation of the CT scans and to the safe performance of endoscopic surgery. Currently, the role of magnetic resonance imaging is restricted to the evaluation of complicated sinusitis, intraorbital and intracranial manifestations of aggressive sinusitis, and sinonasal neoplasms. 4
42. Saylam G, Gorgulu O, Korkmaz H, Dursun E, Ortapamuk H, Eryilmaz A. Do single-photon emission computerized tomography findings predict severity of chronic rhinosinusitis: a pilot study. Am J Rhinol Allergy 2009;23:172-6. Observational-Dx 24 patients Prospective case control study was performed to evaluate whether SPECT findings predict severity of chronic sinusitis and subjective response to medical treatment in patients with CRS. SPECT uptakes were positive in 79.2% (19/24) and negative in 20.8% (5/24) of the patients. SPECT was positive in 4/8 of the patients with limited disease and 15/16 of the patients with extensive disease. In subjective assessment of medical treatment 5/8 of the limited disease vs 1/16 the extensive disease patients had good response; whereas 5/5 of SPECT(-) patients vs 1/19 of SPECT(+) patients had good response. Bone SPECT results were found to be correlated with the stage of CRS. Poorer subjective response was observed in patients with positive SPECT. 3
43. Momeni AK, Roberts CC, Chew FS. Imaging of chronic and exotic sinonasal disease: review. AJR 2007;189:S35-45. Review/Other-Dx N/A To describe the anatomy, pathophysiology, microbiology, and diagnosis of sinonasal disease (chronic and fungal sinusitis, juvenile nasopharyngeal angiofibroma, inverted papilloma, and chondrosarcoma). CT and MRI are the two primary diagnostic imaging methods for evaluating paranasal sinuses. CT is recommended in both adult and pediatric patients. 4
44. Middlebrooks EH, Frost CJ, De Jesus RO, Massini TC, Schmalfuss IM, Mancuso AA. Acute Invasive Fungal Rhinosinusitis: A Comprehensive Update of CT Findings and Design of an Effective Diagnostic Imaging Model. AJNR Am J Neuroradiol. 36(8):1529-35, 2015 Aug. Observational-Dx 42 patients To assess the performance of various CT findings for the identification of acute invasive fungal rhinosinusitis and synthesized a simple and robust diagnostic model to serve as an easily applicable screening tool for at-risk patients. Given the low predictive value of any individual variable, a 7-variable model (periantral fat, bone dehiscence, orbital invasion, septal ulceration, pterygopalatine fossa, nasolacrimal duct, and lacrimal sac) was synthesized on the basis of multivariate analysis. The presence of abnormality involving a single variable in the model has an 87% positive predictive value, 95% negative predictive value, 95% sensitivity, and 86% specificity (R(2) = 0.661). A positive outcome in any 2 of the model variables predicted acute invasive fungal rhinosinusitis with 100% specificity and 100% positive predictive value. 1
45. Groppo ER, El-Sayed IH, Aiken AH, Glastonbury CM. Computed tomography and magnetic resonance imaging characteristics of acute invasive fungal sinusitis. Arch Otolaryngol Head Neck Surg 2011;137:1005-10. Observational-Dx 17 patients To determine radiographic findings on computed tomography (CT) and magnetic resonance imaging (MRI) predictive of acute fulminant invasive fungal sinusitis (AFIFS) in an immunocompromised patient population. No significant differences with regard to baseline characteristics between the 2 groups were identified. There was moderate or substantial agreement (kappa = 0.40-0.77) between the 2 radiologists for all imaging parameters except MRI loss of contrast enhancement (kappa = 0.16). Magnetic resonance imaging was more sensitive than CT for the diagnosis of AFIFS (sensitivity 85% and 86% for both reviewers compared with 57% and 69%). Extrasinus invasion with MRI was the most sensitive individual parameter (87% and 100%). Magnetic resonance imaging and CT had similar specificities, and perisinus invasion was the most specific individual parameter (83% and 83% for MRI compared with 81% and 83% for CT). The positive predictive values were high for both imaging modalities (93% and 94% for MRI compared with 89% and 93% for CT). The negative predictive values were lower for both modalities and varied more between reviewers (71% and 100% for MRI compared with 45% and 67% for CT). 2
46. Choi YR, Kim JH, Min HS, et al. Acute invasive fungal rhinosinusitis: MR imaging features and their impact on prognosis. Neuroradiology. 60(7):715-723, 2018 Jul. Review/Other-Dx 23 patients To present MR imaging features and their impact on prognosis of Acute invasive fungal rhinosinusitis (AIFRS) . All cases showed extra-sinonasal involvement and the orbit was the most common (65.2%, 15/23) location. The lesion enhancement pattern was classified into lack of contrast enhancement (LoCE) (47.8%, 11/23) and homogeneous (34.8%, 8/23) and heterogeneous (17.4%, 4/23) enhancement. Although LoCE showed variable signal intensity (SI), homogeneously or heterogeneously enhancing lesions showed exclusively low SI (100%, 12/12) on T2WI. Among various clinical and imaging factors, LoCE was correlated with coagulation necrosis, probably provoked by numerous fungal hyphae, and was found to be a sole independent prognostic factor for disease-specific mortality (hazard ratio = 16.819; 95% CI, 1.646-171.841, p = 0.017). In addition, patients with LoCE showed worse survival than patients without LoCE (p = 0.008). 4
47. Iqbal J, Rashid S, Darira J, Shazlee MK, Ahmed MS, Fatima S. Diagnostic Accuracy of CT Scan in Diagnosing Paranasal Fungal Infection. J Coll Physicians Surg Pak. 27(5):271-274, 2017 May. Observational-Dx 120 patients To assess the diagnostic accuracy of CTscan in detecting paranasal sinus fungal infections Out of the 120 patients, 71 (59%) were male. The sensitivity, specificity, positive predictive value and negative predictive value of CTwere 96.19%, 93.33%, 99.01%, 77.77%, respectively. The diagnostic accuracy was 95.83%. Kappa statistics showed 82% agreement beyond chance. 2
48. Lai V, Wong YC, Lam WY, Tsui WC, Luk SH. Inflammatory myofibroblastic tumor of the nasal cavity. AJNR Am J Neuroradiol 2007;28:135-7. Review/Other-Dx 1 patient Examine a case of inflammatory myofibroblastic tumor in the left nasal cavity of a 13-year-old girl. MRI revealed T1-weighted hypointense and T2-weighted intermediate-signal-intensity changes with homogeneous contrast enhancement. Angiography revealed the hypervascular nature of the tumor, with blood supplied by mildly hypertrophied terminal branches of the left internal maxillary artery. 4
49. Palacios E, Restrepo S, Mastrogiovanni L, Lorusso GD, Rojas R. Sinonasal hemangiopericytomas: clinicopathologic and imaging findings. Ear Nose Throat J 2005;84:99-102. Review/Other-Dx 7 patients Retrospective review of imaging characteristics, clinical and pathologic findings in patients with sinonasal hemangiopericytoma. Hemangiopericytomas can occur in any part of the body. They are mesenchymal tumors that account for 3% to 5% of all soft-tissue sarcomas and 1% of all vascular tumors. They originate in extravascular cells (pericytes). Some 15%-30% of all hemangiopericytomas occur in the head and neck; of these, approximately 5% occur in the sinonasal area. 4
50. Serrano E, Coste A, Percodani J, Herve S, Brugel L. Endoscopic sinus surgery for sinonasal haemangiopericytomas. J Laryngol Otol 2002;116:951-4. Review/Other-Tx 5 patients To examine cases of haemangiopericytomas treated by a strict endonasal endoscopic approach. Study suggests that when tumor is purely intranasal or strictly located in the ethmoid or sphenoid sinus, it can be removed via an endonasal approach under endoscopic guidance. 4
51. Anschuetz L, Buchwalder M, Dettmer M, Caversaccio MD, Wagner F. A Clinical and Radiological Approach to the Management of Benign Mesenchymal Sinonasal Tumors. ORL J Otorhinolaryngol Relat Spec. 79(3):131-146, 2017. Observational-Dx 93 patients To provide evidence for further refinement of assessment and treatment in the future. The most frequent BMSN recorded in our cohort was osteoma of the frontal sinus. Only one-third of the patients affected were symptomatic at initial presentation. The 2 other common fibro-osseous tumor entities, fibrous dysplasia and ossifying fibroma, were confirmed in 12 and 6 patients, respectively. Patients with soft tissue tumor entities such as hemangioma, glomangiopericytoma, angiofibroma, and hamartoma were all symptomatic and underwent surgical resection. 2
52. Yang B, Wang Z, Dong J. The Specific Magnetic Resonance Imaging Indicators in Predicting Clear-Cell Renal Cell Carcinoma Metastatic to the Sinonasal Region. Journal of Computer Assisted Tomography. 44(1):70-74, 2020 Jan/Feb. Observational-Dx 16 patients To determine the valuable magnetic resonance imaging (MRI) features of sinonasal metastatic clear-cell renal cell carcinoma (cc-RCC), especially focusing on its dynamic-enhanced characteristics. Metastatic cc-RCCs arose from the nasoethmoid region, maxillary sinus, posterior ethmoid and sphenoid sinus, and nasal cavity in 2 patients in each. These lesions were well circumscribed and the mean maximum dimension was 42 mm. The signal intensity of these lesions was isointense to brain stem on both MR T1- and T2-weighted images. All metastatic tumors showed vivid enhancement on enhanced T1-weighted image. Multiple flow voids within these metastatic lesions were identified in 6 patients. Peripheral cyst was detected around the metastatic tumor in 4 patients. Metastatic cc-RCCs exhibited a characteristic type 4 time intensity curve (TIC) similar to that of the internal carotid artery, whereas capillary hemangiomas showed a type 3 TIC on dynamic-enhanced MRI. 1
53. Yang B, Wang Y, Wang S, Dong J. Magnetic Resonance Imaging Features of Schwannoma of the Sinonasal Tract. J Comput Assist Tomogr. 39(6):860-5, 2015 Nov-Dec. Observational-Dx 18 patients To explore the characteristic magnetic resonance imaging (MRI) findings of schwannoma of the sinonasal tract. This entity appeared as a well-circumscribed, oval or fusiform soft tissue mass with a mean greatest diameter of 38 mm. Schwannomas exhibited isointense on T1-weighted image in 12 patients and hypointense in 6. On T2-weighted image, the lesions were heterogeneously isointense in 14 patients and hyperintense in 4. The lesions had heterogeneously moderate and marked contrast enhancement in 2 and 16, respectively. The mottled-, island-, and multicyst-like appearance were identified in 3, 4, and 11, respectively. Compared with inverted papilloma and lobular capillary hemangioma, the type I TIC is characteristic of schwannoma. 2
54. Shih RY, Burns J, Ajam AA, et al. ACR Appropriateness Criteria® Head Trauma: 2021 Update. J Am Coll Radiol 2021;18:S13-S36. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for head trauma. No results stated in abstract. 4
55. Mostafa BE, Khafagi A. Combined HRCT and MRI in the detection of CSF rhinorrhea. Skull Base 2004;14:157-62; discussion 62. Observational-Dx 20 patients To investigate the primary diagnostic method of choice CSF rhinorrhea. rhinorrhea. The sensitivity of HRCT was 88.25%. Fat-suppressed T2-weighted MRI detected a CSF-like density in 18 cases (90%) with a sensitivity of 88.88%. Superimposing the CTs and MRIs accurately localized the site of CSF leakage in 17 of 19 cases with a sensitivity of 89.74%. This finding compares favorably with the results of other techniques. We thus recommend this technique as the primary diagnostic method of choice for the investigation of patients with CSF rhinorrhea. 2
56. Ozgen T, Tekkok IH, Cila A, Erzen C. CT cisternography in evaluation of cerebrospinal fluid rhinorrhea. Neuroradiology 1990;32:481-4. Review/Other-Dx 14 patients To discuss merits and demerits of clinical, radiological and surgical features of 14 patients with cerebrospinal fluid rhinorrhea and had undergone surgical treatment during a three-year period. No results stated in the abstract. 4
57. Stone JA, Castillo M, Neelon B, Mukherji SK. Evaluation of CSF leaks: high-resolution CT compared with contrast-enhanced CT and radionuclide cisternography. AJNR Am J Neuroradiol. 1999;20(4):706-712. Observational-Dx 42 patients To evaluate the use of screening noncontrast high-resolution CT in identifying the presence and site of CSF rhinorrhea and otorrhea and compare it with contrast-enhanced CT cisternography and radionuclide cisternography. High-resolution CT showed bone defects in 30/42 patients (71%) with CSF leak. High-resolution, radionuclide cisternography and CT cisternography did not show bone defects or CSF leak for 12 patients (29%) who had clinical evidence of CSF leak. Among the 30 patients with bone defects, 20 (66%) had positive results of their radionuclide cisternography and/or CT cisternography. For the 21 patients who underwent surgical exploration and repair, intraoperative findings correlated with the defects revealed by high-resolution CT in all cases. High-resolution CT identified significantly more patients with CSF leak than did radionuclide cisternography and CT cisternography, with a moderate degree of agreement. 3
58. Zapalac JS, Marple BF, Schwade ND. Skull base cerebrospinal fluid fistulas: a comprehensive diagnostic algorithm. Otolaryngol Head Neck Surg. 2002;126(6):669-676. Observational-Dx 52 patients To assess the efficacy of current diagnostic modalities in the management of skull base CSF fistulas. beta2-Transferrin analysis of collected specimen was the most efficacious means of confirming a CSF leak. High-resolution CT was the most informative radiographic study, yielding a sensitivity and an accuracy of 87%. MR cisternography, yielding a sensitivity and an accuracy of 78%, was instrumental in localizing the site of leak for a few cases but was most commonly corroborative. Using a graduated diagnostic approach, successful repair was attained in 88% of cases after 1 attempt and 98% after 1 or 2 attempts. 3
59. Eberhardt KE, Hollenbach HP, Deimling M, Tomandl BF, Huk WJ. MR cisternography: a new method for the diagnosis of CSF fistulae. Eur Radiol 1997;7:1485-91. Observational-Dx 30 patients To compare a new MRI method for detecting the existence of cerebrospinal fluid (CSF) fistulae, i. e. MR cisternography, with CT cisternography. The MR examinations were performed with a 1.0-T whole-body MR system, using two T2(*)-weighted sequences, a 3D PSIF (time-inversed fast imaging with steady-state precession, FISP) and a 3D constructive interference steady-state (CISS) sequence. The results of MRI and CT cisternography were compared with the surgical findings. The sensitivity in detecting CSF fistulae with MR cisternography (PSIF: 89.9 %; CISS: 93.6 %) was higher than with CT cisternography (72.3 %). The sensitivity of CT cisternography at detecting CSF fistulae in patients with a size of dural lesion less than 2 mm or in patients with multiple dural lesions is significantly lower compared with the MR method. Although the localization of CSF fistulae always proved possible with MR cisternography, this could only be accomplished wih CT in 70 % of cases. The MR cisternography technique is a new examination method with a higher sensitivity for the detection of CSF fistulae than CT cisternography. The CISS technique is superior compared with PSIF and should be used in patients with high-flow CSF fistulas. 2
60. Goel G, Ravishankar S, Jayakumar PN, et al. Intrathecal gadolinium-enhanced magnetic resonance cisternography in cerebrospinal fluid rhinorrhea: road ahead?. Journal of Neurotrauma. 24(10):1570-5, 2007 Oct. Observational-Dx 10 patients To evaluate the utility of intrathecal gadolinium-enhanced MR cisternography (GdMRC) in patients with CSF rhinorrhea Ten consecutive patients of CSF rhinorrhea (five spontaneous, four post-traumatic, and one post-operative) were evaluated with GdMRC. Nine of the patients underwent intrathecal contrast CT and CISS-3D examinations in addition. Each of studies was reviewed independently by three neuroradiologists blinded to results of other modalities. Surgery was planned after consensus and surgical correlation obtained in nine cases. The fistulous site was clearly demonstrated by using GdMRC in eight patients, CISS-3D in six, and intrathecal CT in three patients. The site of leakage was confirmed surgically in all the patients. One patient was found to be false negative both by intrathecal CT and GdMRC, and in one patient no fistulous site was demonstrated by any of the modalities and surgery was not offered. No adverse reaction was seen in any of the patients. GdMRC is a novel method of confirmation and localization of CSF fistula with potential for routine clinical application. Diagnosis and localization of fistulous site is better demonstrated due to its high-contrast resolution, absence of bony artifacts, and direct multi-planar imaging. 2
61. Shetty PG, Shroff MM, Sahani DV, Kirtane MV. Evaluation of high-resolution CT and MR cisternography in the diagnosis of cerebrospinal fluid fistula. AJNR Am J Neuroradiol 1998;19:633-9. Observational-Dx 45 patients To determine the accuracy of MR cisternography and plain high-resolution CT as a noninvasive alternative to CT cisternography in the diagnosis of CSF fistula in patients with clinically suspected CSF rhinorrhea. Plain high-resolution CT successfully depicted the presence or absence of CSF fistula in 42 of 45 patients, whereas MR cisternography was correct in 40 patients. MR cisternography or plain high-resolution CT correctly showed the site(s) of CSF fistula leakage in 36 of the 38 cases proved surgically. The combined techniques also correctly indicated the absence of CSF leakage in seven cases, six of which were confirmed at CT cisternography. Both MR cisternography and high-resolution CT failed to definitively locate the CSF fistula in two patients. High-resolution CT was accurate in 93% of patients, whereas MR cisternography was accurate in 89% of patients. The combination of high-resolution CT and MR cisternography was accurate in 96% of patients. 2
62. La Fata V, McLean N, Wise SK, DelGaudio JM, Hudgins PA. CSF leaks: correlation of high-resolution CT and multiplanar reformations with intraoperative endoscopic findings. AJNR Am J Neuroradiol 2008;29:536-41. Observational-Dx 19 patients To determine how well coronal and sagittal multiplanar reformatted (MPR) images generated from a high-resolution axial dataset correlate with intraoperative findings in a group of patients with clinically proved CSF leaks At endoscopy, 22 leaks of CSF were identified in 18 of 19 patients. CT correctly predicted the site of the leak in 20 (91%) of 22 cases and was accurate (within 2 mm of the endoscopic measurement) in 15 (75%) of 20 cases preoperatively localized. The CT measurement of the skull base defect differed from the endoscopic size in 5 (25%) of 20 cases, ranging from 7.4 mm below to 13 mm above the intraoperative measurement. When analysis was limited to the subgroup of 10 patients who had 0.625-mm axial images, the accuracy was improved, and of the 11 CSF leaks described at CT, all were verified at endoscopy. In addition, the submillimeter CT accurately measured the size of the osseous defect in 9 (82%) of 11 cases. In the remaining 2 (18%) of 11 cases, CT minimally overestimated the size of the osseous defect by only 3 mm. 4
63. Algin O, Hakyemez B, Gokalp G, Ozcan T, Korfali E, Parlak M. The contribution of 3D-CISS and contrast-enhanced MR cisternography in detecting cerebrospinal fluid leak in patients with rhinorrhoea. Br J Radiol 2010;83:225-32. Observational-Dx 17 patients To evaluate the value of unenhanced (three-dimensional constructive interference in steady state (3D-CISS)) and contrast-enhanced MR cisternography (CE-MRC) in detecting the localisation of cerebrospinal fluid (CSF) leak in patients with rhinorrhoea. 17 patients with active or suspected CSF rhinorrhoea were included in the study. 3D-CISS sequences in coronal and sagittal planes and fat-suppressed T1-weighted spin-echo sequences in three planes before and after intrathecal contrast media administration were obtained. Images were obtained of the cribriform plate and sphenoid sinus. In addition, high-resolution CT (HRCT) was performed in order to evaluate the bony elements. The leak was present in 9/17 patients with 3D-CISS and 10/17 patients with CE-MRC. The leak from the cribriform plate to the nasal cavity in six patients and from the sphenoid sinus in four patients was nicely shown by CE-MRC. Eight of those patients were surgically treated, but spontaneous regression of the symptoms in two precluded any intervention. The leak localisations shown with CE-MRC were fully compatible with surgical results. The sensitivities of HRCT, 3D-CISS and CE-MRC for showing CSF leakage were 88%, 76% and 100%, respectively. In conclusion, 3D-CISS is a non-invasive and reliable technique, and should be the first-choice method to localise CSF leak. CE-MRC is helpful in conditions when there is no leak or in complicated cases with a positive beta2-transferrin measurement. 3
64. Whitehead MT, Cardenas AM, Corey AS, et al. ACR Appropriateness Criteria® Headache. J Am Coll Radiol 2019;16:S364-S77. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for headache. No results stated in the abstract. 4
65. Selcuk H, Albayram S, Ozer H, et al. Intrathecal gadolinium-enhanced MR cisternography in the evaluation of CSF leakage. AJNR Am J Neuroradiol 2010;31:71-5. Observational-Dx 85 patients To describe our experience in analyzing clinically suspected cranial CSF fistulas by using MR imaging combined with the intrathecal administration of a gadolinium-based contrast agent. We observed objective CSF leakage in 64 of 85 patients (75%). The CSF leak was located in the ethmoidal region in 37 patients (58%), in the superior wall of the sphenoid sinus in 8 patients (13%), in the posterior wall of the frontal sinus in 10 patients (15%), in the superior wall of the mastoid air cells in 6 patients (9%), and from the skull base into the infratemporal fossa in 1 patient (2%). Two patients (3%) showed leakage into >1 paranasal sinus 4
66. Zhang G, Wang Z, Hao S, et al. Clinical evaluation of SPECT/CT fusion imaging for the diagnosis and determination of localisation of cerebrospinal rhinorrhea. Clin Imaging 2013;37:847-51. Review/Other-Dx N/A To determine the clinical value of fructosamine assay for monitoring type II diabetic patients, the correlation of fructosamine and HbA1c, glycemia, cholesterol and triglycerides No results stated in the abstract. 4
67. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. Review/Other-Dx N/A To provide evidence-based guidelines on exposure of patients to ionizing radiation. No abstract available. 4
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