CT of the paranasal sinuses: a review of the correlation with clinical, surgical and histopathological findings

Computerized tomography (CT) of the paranasal sinuses provides valuable information but this should be interpreted in the context of the history and examination as the prevalence of incidental mucosal changes in an asymptomatic population is approximately 30%. A review of the presence or extent of the various anatomical variations that are found in the paranasal sinuses does not differ between a symptomatic and an asymptomatic population. This makes it unlikely that these are very important in either initiating or sustaining paranasal sinus disease. CT provides an excellent map to help the sinus surgeon operate. CT provides information about the extent of mucosal disease but this correlates poorly with symptoms, surgical findings and histopathology. CT does provide invaluable information to help in the diagnosis of atypical sinus infections, malignancy and in the management of the complications of rhinosinusitis. A normal CT in a patient with facial pain should make the doctor consider another diagnosis. In essence, CT helps to support a clinical diagnosis but it should not be interpreted out of context. and it is therefore vital that doctors communicate the clinical picture to their radiological colleagues, and that they learn to interpret the radiographs.