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. DNS to Left / Right 2. Bony spur 3. Crista Galli 4. Frontal sinus 5. Frontal cells 6. Ager Nasi 7. Ethmoid roof 8. 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 DISTRI-

BUTION

MALESFEMALES

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). Series1

0

10

20

30

40

50

60

70

80

CT MRI PLAIN RA-DIOGRAPHS

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 = 0.799547-1.0), specificity = 80% (CI = 0.298792- 0.989)

Series10

10

20

30

40

50

60

70

80

90

CT MRI PLAIN RA-DIOGRAPHS

DISCUSSION 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.

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