Transcript Abstract id - Stanley Radiology

ABSTRACT ID- IRIA - 1164
TITLE : TO COMPARE X-RAY AND NCCT SCAN
WITH MRI FOR SCREENING OF PARANASAL
SINUS DISEASE
AIMS AND OBJECTIVES

To compare x-ray and NCCT scan with MRI for
screening of paranasal sinus disease
NEED FOR STUDY
Radiograph PNS Water`s view is the most
commonly requisitioned imaging modality for
screening of paranasal sinus disease
 However it has very poor sensitivity and
specificity
 CT scan is the present gold standard for
diagnosis of paranasal sinus disease but it
involves radiation hazard
 MRI can offer radiation free alternative, with the
development of fast sequences, it can be a rapid
tool for detecting PNS pathology

MATERIALS AND METHODS
Sample Size: 25 patients referred for X-ray and
NCCT PNS to radiology dept
 Radiograph PNS and NCCT of the PNS were
performed as requested by the referring doctor,
and thereafter the subjects underwent MRI PNS
with T2 and T1 weighted sequences
 Study duration: Apr 2013 to Mar 2014

INCLUSION CRITERIA:
 Patients referred for imaging of PNS with X-ray and
NCCT scan, who volunteer to undergo MRI of PNS
were included in the study
EXCLUSION CRITERIA:
 Patients having contraindication to X- rays and MRI
such as :
 Pregnancy
 Electromagnetic /ferromagnetic implant/ cochlear
implant
 Claustrophobia
CONSENT: Informed consent obtained from the
patients/ guardians/parents
MATERIALS AND METHODS:IMAGING
PROTOCOL
Plain Radiography
 In our study only
PNS water`s view was
included as it is the
most commonly
requisitioned view
 Equpment : Mindray
500 mA static
machine with CR
cassette
 kVp of 60-70
 mAs of 50-60

IMAGING PROTOCOL: CT SCAN
Equipment: Philips brilliance 16 slice helical
Multidetector CT
 Scan protocol : Patient head first supine with
hard palate parallel to scan plane
 Collimation : 0.8 mm
 FOV : Anterior walls of the frontal sinuses to the
posterior wall of the sphenoid sinus
 kVp : 120 -130
 mAs : 80 -100
 Scan acquisition done in axial plane with
multiplanar reconstruction

IMAGING PROTOCOL : MRI





Position: Head first supine with
head and neck coil
Localiser: Laser beam localizer
was placed over glabella. Three
plane localizer was taken
Following T1 and T2 weighted
sequences were performend on
first two index cases for selection
of best and rapid sequence for
screening of PNS disease
T1 FLASH and T2 TSE 3mm 0
distance were selected
Only coronal acquisition was
carried out

T2 WI:






T2 TSE 3mm
T2 TSE 2mm
HASTE
PDFS
GRE
T1 WI:




T1 TSE
T1 FLASH
T1 3D MPR
T1 VIBE FS
REPORTING CHECKLIST
1.
2.
3.
4.
5.
6.
7.
8.
DNS to Left / Right
Bony spur
Crista Galli
Frontal sinus
Frontal cells
Ager Nasi
Ethmoid roof
Maxillary sinus
9. Uncinate process
10. Middle turbinate
11. Ethmoid bulla
12. Hiatus semilunaris
13. Lamina papyracea
14. Haller cells
15. Sinus lateralis
16. Posterior ethmoid air
cells
17. Sphenoethmoidal
recess
OBSERVATION AND RESULTS
Age group: 7-67 yrs
 68 % males
 32 % females

GENDER
DISTRIBUTION
MALES
FEMALES
RESULTS : ANATOMICAL VARIATIONS





19 of the 25 patients
were detected to have
various anatomical
variation
MRI detected 18 of
these cases
Only one case could be
detected on radiography
Sensitivity = 94.7 %
(CI: 0.718 to 0.997)
Specificity = 100%
(CI: 0.516 to 1).
80
70
60
CT
50
MRI
40
30
20
10
0
PLAIN
RADIOGRAPHS
COMPARATIVE ANALYSIS: DETECTION OF
MUCOSAL PATHOLOGY
20 patients detected
to have mucosal
pathologies on NCCT
 MRI detected all these
cases along with a
false positive
 Radiographs detected
only 5 of these cases
 Sensitivity of MRI=
100% (CI = 0.7995471.0), specificity = 80%
(CI = 0.298792- 0.989)

90
80
70
60
CT
50
MRI
40
PLAIN
RADIOGRAPHS
30
20
10
0
DISCUSSION



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Plain radiography shows poor sensitivity and
specificity in detection of bony pathologies and
anatomical variants
MRI as a screening modality has higher sensitivity
and specificity as compared with radiograph PNS
Water`s view and comparable to CT scan
MRI can be performed in patients where only
screening and detection of PNS pathology is
concerned
MRI is of great advantage in cases where radiation
exposure is of high concern and in public institutions
where cost of MRI is not a factor for the patient.
NCCT can be performed when patient is planned for
FESS
CONCLUSION
MRI is more sensitive and specific for screening
of paranasal sinus disease as compared to X rays
and is almost comparable to NCCT for detection
of mucosal disease
 With a fast MRI screening protocol (T2 coronal
and T1 FLASH) it is possible to replace X-ray
PNS as the screening modality
 CT scan can be performed when FESS is planned
to delineate the bony landmarks.

ILLUSTRATIVE CASES
ILLUSTRATIVE CASES
ILLUSTRATIVE
CASES
ILLUSTRATIVE CASES
ILLUSTRATIVE CASES
REFRENCES
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3.
Konen E, Faibel M, Kleinbaum Y, et al. The value of occipitomental
(Waters’) view in diagnosis of sinusitis: a comparative study with computed
tomography. Clin Radiol 2000; 55:856–860.
4.
Girish M. Fatterpekar, Bradleyn.Delman,Peterm.Som. Imaging the
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5.
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