Radiological appearance of clinical inflammatory sinus disease with bone destruction. The significance of contrast enhancement

It is generally accepted that conventional imaging techniques have limitations in their ability to differentiate benign and malignant disease processes resulting in bone destruction. Although computed tomography (CT) has proved helpful in the diagnosis of such lesions in the paranasal sinuses, the underlying radiological criteria are unclear and the value of contrast enhancement appears limited. Conventional radiographs and CT scans, with dynamic contrast infusion, from five patients in whom a provisional diagnosis of antral carcinoma had been made were reviewed in the light of a subsequent histopathological diagnosis of benign inflammatory disease. In four of these patients, a band of enhancement was demonstrated to parallel the antral walls which, in three cases, remained intact despite underlying bony defects. Their finding is significant in that it demonstrates mucosal integrity, thus making the radiological diagnosis of antral carcinoma less attractive and allowing assessment of the extent of inflammatory soft tissue changes. Thus the use of contrast-enhanced CT is recommended in the assessment of patients in whom sinus disease with bone destruction has been identified on conventional radiographic examination. © 1994.