The role of CT imaging in rhinosinusitis and the need for a standardized CT reading system

Chronic rhinosinusitis is a prevalent disease and a significant cause of morbidity to the patients it affects. The diagnosis of chronic rhinosinusitis is based on the patient's clinical history, findings on physical examination, and findings on nasal endoscopy. CT scanning of the sinuses has become the standard diagnostic imaging modality for evaluation of chronic rhinosinusitis. CT scanning is an objective means of evaluating the sinonasal cavities for the presence and extent of disease and is helpful in defining the bony anatomy of the sinuses and their drainage pathways. Recent advances in CT technology, including the introduction of helical (spiral) CT and CT computer-assisted techniques for endoscopic surgery, have further aided in the diagnosis and treatment of these patients. The relationship between symptom severity and CT scan findings, however, remains poorly defined. Confusion and frustration among clinicians occur from radiologists' lack of use of standardized terminology in CT reports and the lack of a standardized method of CT interpretation. This paper reviews the recent literature focused on the role of CT imaging in the diagnosis and follow-up of patients with rhinosinusitis. In addition, suggestions for systematic, quantitative, and consistent CT interpretation are described.