RADIOLOGICAL APPEARANCE OF CLINICAL INFLAMMATORY SINUS DISEASE WITH BONE DESTRUCTION - THE SIGNIFICANCE OF CONTRAST ENHANCEMENT

It is generally accepted that conventional imaging techniques have lim itations in their ability to differentiate benign and malignant diseas e processes resulting in bone destruction. Although computed tomograph y (CT) has proved helpful in the diagnosis of such lesions in the para nasal sinuses, the underlying radiological criteria are unclear and th e value of contrast enhancement appears limited. Conventional radiogra phs and CT scans, with dynamic contrast infusion, from five patients i n whom a provisional diagnosis of antral carcinoma had been made were reviewed in the light of a subsequent histopathological diagnosis of b enign inflammatory disease. In four of these patients, a band of enhan cement was demonstrated to parallel the antral walls which, in three c ases, remained intact despite underlying bony defects. Their finding i s significant in that it demonstrates mucosal integrity, thus making t he radiological diagnosis of antral carcinoma less attractive and allo wing assessment of the extent of inflammatory soft tissue changes. Thu s the use of contrast-enhanced CT is recommended in the assessment of patients in whom sinus disease with bone destruction has been identifi ed on conventional radiographic examination.