ARRS 2022 Abstracts


E2080. An Organized Approach to Interpreting CT of the Paranasal Sinuses, Review of Common Sinonasal Anatomic Variants
  1. Issa Khoury; Montefiore Medical Center
  2. Jacqueline Bello; Montefiore Medical Center
  3. Keivan Shifteh; Montefiore Medical Center
A typical paranasal sinus CT examination includes evaluation of the paranasal sinuses, nasal cavity, nasal septum, sinocranial/sinoorbital junctions, and numerous other structures including intracranial components, temporal bone, and the orbits. Given the sheer volume of anatomy in this region, it is crucial to establish an organized approach to the interpretation of the paranasal sinus CT imaging. In this exhibit, we provide a classification system based on anatomic subdivisons to help guide interpretation. Special attention will be paid to landmarks of significant surgical importance, including several anatomic variants encountered in daily practice.

Educational Goals / Teaching Points
The goals of this exhibit are to help viewers develop an organized approach to interpreting sinus CT; review the relevant normal anatomy, with particular attention to anatomy of surgical importance; and review common sinonasal anatomic variants and describe how these may contribute to sinus pathology.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
CT imaging findings of the sinuses will be reviewed, with an overview of normal and variant anatomy based on the following classification. I) Paranasal sinuses (frontal, ethmoid, sphenoid, maxillary), development, aeration, drainage pathways, anatomic variants. II) Nasal cavity, nasal septum (cartilaginous and osseous portions), turbinates (superior, middle, inferior), meati (superior, middle, inferior). III) Sinocranial / sinoorbital junctions: cribriform plate, fovea ethmoidalis, planum sphenoidale, lamina papyracea. IV) Review of other structures: intracranial components, temporal bone, orbits. Several anatomic variants will be highlighted as well, including haller cell, concha bullosa, paradoxical rotation of the middle turbinate, nasal septal deviation, agger nasi cell, frontal cells (type I–IV), frontal bullar cell, suprabullar cell, and interfrontal sinus septal cells. In addition, we will review the surgical danger areas using the well-known "CLOSE" mnemonic and address common mimics a radiologist can encounter in practice, including meningoencephaloceles and fibrous dysplasia.

An organized approach to the interpretation of the paranasal sinus CT will allow the radiologist to systematically review each study in an efficient manner and generate a complete report. Knowledge of paranasal sinus CT anatomy enables accurate assessment of normal variants and pathological entities necessary to ensure safe and successful surgical intervention. Additionally, familiarity with the anatomic variants of the nasal cavity and paranasal sinuses is critical for the successful interpretation of imaging studies. Such variants are significant as they can predispose the individual to recurrent sinus disease. These variants also serve as useful landmarks during endoscopic surgery.