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CT Scan of the Paranasal Sinuses: History, Basic Concepts, Anatomy. CT scanning can be helpful in the diagnosis of acute and chronic sinusitis, neoplastic and inflammatory processes, and other problems (eg, congenital anomalies).

Acute sinusitis is caused by bacterial or fungal infections usually secondary to an obstructed sinus cavity. Install Linux On Lenovo Yoga 11 Inch. Structural anatomic variations, acute edema of sinonasal mucosa in response to infection or allergens, and compromise of nasociliary flow can all contribute to acute and chronic sinusitis. CT findings of sinus opacification, air- fluid levels, and thickened localized mucosa are all findings of acute sinusitis. Many nonspecific CT findings, including thickened turbinates (nasal cycle vs allergic process vs inflammation) or diffusely thickened sinus mucosa (allergic disease vs chronic sinusitis), may be associated with several sinonasal conditions. CT findings suggestive of chronic sinusitis include mucosal thickening, opacified air cells, bony remodeling, and bony thickening due to inflammatory osteitis of the sinus cavity walls.

Bony erosion can occur in severe cases, especially if associated with massive polyps or mucoceles. CT findings of bony destruction should alert the clinician to also consider less common diseases, such as sinonasal tumors or granulomatous disease processes. See the image below. Sinonasal polyps can create sinus disease by obstruction or mass effect and by causing secondary infections.

Sinonasal polyps appear on CT scans as nodular or rounded masses and amorphous opacified blobs of tissue. Bony remodeling can occur, but it is typically subtle, which is expected from the usual slow growth pattern of sinonasal polyps and benign processes in general. See the image below. Fungal sinusitis can be divided into invasive fungal sinusitis, chronic noninvasive fungal sinusitis (mycetoma), and allergic fungal sinusitis. Invasive fungal sinusitis due to mucormycosis or aspergillosis is typically a disease that affects immunocompromised patients and can have a fulminant course.

Early in the disease process, opacification of sinuses is seen. Disease progression to a more fulminant state accompanies vascular invasion and localized destruction. Intracranial, cavernous sinus, and orbital complications may occur with advanced infections. CT findings mirror these processes with expanding localized destruction of bone. Mycetomas appear inside the sinus cavity as noninvasive balls of fungus.

CT findings may include a localized sinus opacification, homogenous mass that does not change shape with head position (gravity), and a mass with presence of calcifications (found in 2. Allergic fungal sinusitis (AFS) may occur in atopic patients as a hypersensitivity reaction to fungal antigens.

Many patients with AFS may also have various degrees of nasal polyposis. On CT scans, heterogeneous opacification can be seen with a typical pattern of central hyperdense areas of opacification surrounded by less dense areas of opacification. Calcified areas can sometimes be seen. Bony expansion, remodeling, and even diffuse bony destruction can be seen in advanced cases.

How to cite this article: Arya S, Chaukar D, Pai P. Imaging in oral cancers. Indian J Radiol Imaging 2012;22:195-208. CT scanning of the head is typically used to detect infarction, tumors, calcifications, haemorrhage and bone trauma. Of the above, hypodense (dark) structures can. History of my problem: For as long as I can remember, I have had a problem with my hyoid bone popping out and causing excrutiating pain. It is always the same - the.

How to Read a CT Scan. A computed tomography (CT) scan can create cross-sectional images of any part of your body using special X-rays and a computer.http://www.

With experience, CT findings can be accurately correlated with anatomic and clinical realities of the particular patient. As for all radiologic surveys, sinus CT scans must be read with a systematic approach. After the primary survey of the CT scan is completed, including patient name, indications for the CT scan, type of scan, cross- sectional view being discussed, and major radiologic findings, particular attention is directed toward potential . Reading the CT scan from anterior to posterior (on coronal views) or from top to bottom (on axial sections) can help organize one's approach in analyzing structures to be interpreted.

For initial orientation, a number of important paranasal sinus structures are identified, including the frontal sinuses, the frontal recess, the agger nasi cells, the anterior ethmoidal sinus cells, the ethmoid roof, the ethmoidal bulla, the uncinate process, the ethmoidal infundibulum, the maxillary sinus, the middle meatus, the nasal septum, the turbinates, the basal lamella, the posterior and anterior ethmoid cells, and the sphenoid sinus. See the image below. If the CT scan is being read as a prelude to surgery, a number of additional anatomic and structural features need to be considered. The thickness, orientation, and most medial position of the lamina papyracea must be noted. Any dehiscences or excessive medial bowing of this thin bone should be noted prior to surgery.

Similarly, the depth of the olfactory fossa must be recognized. The relationship of the sphenoid sinus and posterior ethmoid air cells vis a vis the internal carotid artery and optic nerves should be noted.

The Radiology Assistant : Bone tumor A- GABCkey facts: Aneurysmal bone cyst typically presents as a painful expansile or 'aneurysmal' well- defined osteolytic lesion in a patient younger than 3. Other locations include the proximal humerus or spine, but many other bones are possible. In the spine osteoblastoma may mimic ABC. In the proximal humerus or femur of young children there is frequently a differential diagnosis of ABC, SBC and fibrous dysplasia. Cavities filled with blood can also be found in giant cell tumor, osteoblastoma and chondroblastoma (i. ABC). The differential diagnosis based on the CT is: ABC, Osteoblastoma and Tuberculosis (1).

ABC (3)On the left images of an aneurysmal or expansile well- defined osteolytic bone lesion in the fibula. The T2- weighted MR- image shows the fluid content and on the T1- weighted image there is a subtle fluid- fluid level.

Differential diagnosis: SBC or fibrous dysplasia with cystic changes. ABC in the proximal phalanx. ABC (4) On the left images of an aneurysmal or expansile well- defined osteolytic bone lesion in the proximal phalanx. Notice the expansion and the enhancing rim. ABC (5) On the left an expansile well- defined osteolytic lesion with a sclerotic margin in the talus. Axial PD- weighted image shows lobulated contours and cystic appearance with fluid- fluid level (arrow). Most likely diagnosis: ABC.

Differential diagnosis: chondroblastoma with secondary ABC. ABC versus Adamantinoma.

Notice resemblance between intracortical ABC in tibia (left) and Adamantinoma (right). ABC (6) - atypical case. On the left two different patients with an intracortical or subperosteal osteolytic well- defined lesion in the tibia. The lesion on the far left was thought to be an adamantinoma because of the localisation in the anterior tibial cortex. At biopsy it proved to be an ABC.

The image on the right is an adamantinoma. Continue with the additional examinations in this ABC. Here the MR, bone scan and the sonogram of the same patient with ABC. On the axial T2. WI with fat saturation subtle sedimentation is seen.

The bone marrow is completely normal. ABC (7)Here another ABC in the talus. It is barely visible on the X- rays and was initially missed. MR shows typical fluid- fluid levels. ABC (8) On the left another ABC, located in the distal femur. The plain radiograph shows a layered periosteal reaction and Codman triangle in direct relationship to an expansile lytic lesion with a thin peripheral bone shell.

CT also reveals the subperiosteal origin of the lesion with secondary involvement of the cortical bone. Axial T2- weighted image with fatsat and contrast enhanced T1- weighted image with fat sat show multiple fluid- fluid levels with rim enhancement of the cavities filled with blood. This is typical for an aneurysmal bone cyst. Adamantinomakey facts: Rare low- grade malignant lesion, exclusively found in the diaphysis of the anterior cortex of the tibia. There is a second lucency separately more proximal within the cortical bone. Axail CT image prior to biopsy demonstrates the lytic appearance of the lesion within the thickened cortical bone. In the differential diagnosis could have been chondromyxoid fibroma or fibro- osseous lesion, however, the separate cortical lesion strongly suggests adamantinoma, which is almost exclusively found in the tibia and often multicentric.

Adamantinoma (3)Adamantinoma of the tibia in another patient. There is an ovoid osteolytic lesion within the anterior cortical bone. Lobulated high signal intensity on axial T2- weighted image. There is no extension into the bone marrow.

Homogeneous enhancement on T1- weighted image after Gd- DTPA. Adamantinoma (4)On the left a radiograph and CT- image of another typical adamantinoma.

CT was performed prior to biopsy. Here a mixed sclerotic- lytic lesion, cortically based in the tibia shaft in a 1. There is also a lucent lesion in the cortex of the fibula. Differential diagnosis includes adamantinoma or osteofibrous dysplasia, based on the typical location, age (2nd- 3rd decade) and radiographic appearance. Biopsy showed adamantinoma. Continue with the MR. Same patient. Sagittal T2- weighted fat- suppressed images demonstrate multiple foci of high SI within the cortices of tibia and fibula.

Post- operative situation on the right. Care should be taken that each focus is entirely removed.

MRI is pivotal for demonstrating the intramedullary and soft tissue extension. Adamantinoma (5)Here another patient with an adamantinoma. MR reveals also extension within the bone marrow compartment. Chondromyxoid fibroma key facts: CMF is a rare benign osteolytic lobulated lesion preferentially found eccentric in the tibia metaphysis and less common in the femur and foot.

Mainly found in young adults. The lesion may cause cortical expansion. Calcifications are usually not present. Differential diagnosis: ABC, NOF and fibrous dysplasia.

Chondromyxoid fibroma (2)Eccentric well- defined lytic lesion in the metaphysis of the proximal tibia in a young child. T1- weighted images before and after Gd- DTPA demonstrate some expansion and lobulation.

After the administration of Gadolinium there is thick peripheral enhancement. Chondromyxoid fibroma (4)On the left a diaphyseal cortically based lytic lesion with expansion and a thin peripheral bone shell.

There is peripheral enhancement on the axial T1- weighted image with fat saturation. Additional MR imaging and bone scintigraphy may be helpful to make the diagnosis of chondrosarcoma more or less likely. Chondrosarcoma (3) On the left a massive chondrosarcoma of the skull base with extension to the nasal and paranasal cavities and orbita. A T1- weighted image after Gd shows typical septal and nodular enhancement. Chondrosarcoma (4) On the left a chondrosarcoma in the proximal tibia diaphysis. The tumor is recognized by subtle calcifications in the proximal part.

The distal border is not well defined. Notice endosteal scalloping at the medial side which is a hallmark of chondrosarcoma. MR better defines the extension of the lesion. MRI also demonstrates the endosteal scalloping. Chondrosarcoma (5) Partially calcified chondroid tumor in the proximal tibia. Based on the imaging findings it is not possible to differentiate between an enchondroma or a low grade chonrosarcoma.

On the coronal T1- weighted MR the typical chondroid morphology is seen. There is no evidence of endosteal scalloping. Continue with bone scan and dynamic MR. Low grade chondrosarcoma: Bone scintigraphy (left) and fast dynamic contrast enhanced MR (right)Bone scintigraphy of the same patient shows increased uptake in the lesion. This increased uptake in a chondroid tumor is in favor of the diagnosis of a low grade (grade I) chondrosarcoma.

The fast dynamic contrast enhanced MR image with subtraction revealed early and progressive enhancement, which is also in favor of the diagnosis of a grade I chondrosarcoma. Chondrosarcoma (6)On the left a patient with a calcified lesion in the proximal diaphysis of the tibia. On the sagittal T1- weighted CE image. The calcifications with low SI are present in the proximal part. On the MR, the lesion is far more extensive than suspected on the plain radiograph at first glance. On second inspection you will notice the subtle endoteal scalloping of the tumor on the radiogrph. The large diameter and the scalloping favor the diagnosis of a chondrosarcoma.

Chondrosarcoma (7)On the left a patient with a chondrosarcoma of the right acetabulum. On the CT expansion and subtle calcifications are present. On the coronal T2- weighted image the tumor is seen as a large lobulated mass with very high SI, which is typical for chondroid tumors. The T1- weighted image after Gd shows typical peripheral nodular enhancement. In the center there is no enhancement. This is probably due to a large myxoid component. Calcificatons contribute to the low SI within the tumor.

Diff. Subtle calcifications are present indicating chondroid matrix. CE- T1. WI with fatsat shows typical peripheral nodular enhancement.