MRI of the frontal and nasal sinuses. The place of magnetic resonance imaging in the diagnosis of pathology of the paranasal sinuses. The main contraindications for use

Computed tomography of the sinuses is one of the most informative diagnostic methods used in otorhinolaryngology.

A CT scan provides information about morphological changes tissues, structural disorders, injuries and neoplasms in the nasal cavity. High accuracy of the survey is achieved by exposure to the nasopharynx of x-rays, which form a three-dimensional image of the nasal cavity.

Computed tomography of the sinuses is a high-precision method for diagnosing diseases and injuries of the nasopharynx and sinuses. The pictures obtained during the procedure make it possible to establish and differentiate the diagnosis, serve as the basis for the appointment of effective therapy.

High information content and super-accuracy compensate for the only drawback of CT - X-ray irradiation, the dose of which is lower than that of X-rays.

Depending on the method of the procedure, CT of the nasal cavity is divided into types. The main types include:

Standard CT without contrast.
CT of the nasal cavity with contrast. In this case, the patient is injected with a contrast agent containing iodine, which better shows the soft and bone tissues, cartilaginous joints of the cavity. Basically, contrast is used to increase the information content of the procedure, as well as in cases where there are suspicions of a tumor.
MSCs of the nasopharynx. Multislice computed tomography is also performed using x-ray exposure, as CT, but refers to a more effective diagnostic method.

MSCT paranasal sinuses nose allows you to take up to 300 images per revolution of the device (whereas CT takes from 1 to 10 images). The image quality with MSCT is higher than with standard computed tomography.

The main indications for the appointment of CT

Diagnosis of the nasopharynx using computed tomography is prescribed for diagnosis, before and after the therapy used. The main reasons for the appointment of the procedure are:

inaccuracy of images obtained on radiography;
chronic inflammatory processes nasopharynx and paranasal sinuses;
the presence of dacryocystitis - inflammation in the lacrimal sacs, which also affects the lacrimal ducts;
previous injuries, especially those accompanied by a curvature of the septum;
the presence of neoplasms (polyps, malignant and benign tumors, cysts, etc.);
abnormal structure of the skull, affecting the state of the nasopharynx;
Availability foreign objects in the nasal cavity;
transferred infectious diseases;
transfer of diseases such as rhinitis, sinusitis, liquorrhea.

Computed tomography of the paranasal sinuses is also indicated for headaches (especially when tilting the head), pain in the eyes. Similar symptoms may indicate inflammatory processes in maxillary sinuses ah (for example, with sinusitis). Also, the procedure is prescribed before surgical intervention to assess the structure and condition of the nasal cavity.

In the presence of tumor-like neoplasms, CT of the nasal cavity will determine the etiology of tumors - are they benign or malignant. Such a study also helps to differentiate the nature of polyps, to identify the cause of their occurrence in the paranasal sinuses or nasopharynx.

Key advantages of the method

Diagnosis of the nasal cavity using CT has significant advantages. These include:

cyst ( White spot left) in the picture of the sinuses

high information content and quality of images (diagnosis is carried out using a high-resolution 3-D image);
low radiation exposure in the diagnosis of the nasopharynx in comparison with x-rays;
speed of scanning and minimum time for research (the procedure takes from several minutes to half an hour);
painlessness and a minimum list of contraindications.

The main contraindications for use

In some cases, the diagnosis of the paranasal sinuses using computed tomography is not carried out. The list of contraindications is minimal, as the procedure is safe and painless. The main contraindications for the examination include:

pregnancy (especially the first trimester);
lactation period - a relative contraindication (it is forbidden to breastfeed within 24 hours after passing the examination);
overweight (from 180 kg and above), since the device has a restrictive limit;
allergic reactions to the contrast agent;
age up to 7 years (the procedure is prescribed only for health reasons).

Diagnosis of the nasopharynx using computed tomography may be prohibited if there is diabetes, melanoma, as well as in pathologies thyroid gland, kidney, liver, etc.

The specifics of the CT scan of the nasal cavity

Patients who are scheduled for examination of the maxillary sinuses and the nasopharynx in general should be prepared for CT. Preparation involves collecting data from the patient about the presence of existing diseases, medication, etc.

In addition, the radiologist may ask you to remove metal objects (jewelry, watches, removable dentures etc.). If the examination of the maxillary sinuses occurs with the use of contrast, then the substance is administered intravenously 30-45 minutes before the procedure.

The procedure algorithm is as follows:

The patient is placed on the couch of the tomograph (on the back or face down). At the same time, the chin should protrude forward so that the x-ray tubes better scan the nasal cavity.
The patient is immobilized - this can be done with special rollers and belts. During the entire examination, it is required to remain calm in order to exclude inaccurate images.
The patient is sent to the tomograph capsule through the portal, where the detectors and X-ray tubes rotate. With their help, slices are created, which are converted into a three-dimensional image.

Modern equipment allows you to make a survey quickly - the duration can be from several minutes to half an hour.

Display of sinuses during MRI (video)

MRI of the nasal cavity as an alternative to CT

In some cases, computed tomography is not possible. In such situations, an MRI of the paranasal sinuses is prescribed. Magnetic resonance imaging makes it possible to establish a diagnosis with higher accuracy due to the increased information content of the image.

When conducting an MRI of the nose, a magnetic field is used, which shows the structure of the nasopharynx, the morphological structure of tissues and neoplasms in the cavity.

MRI of the paranasal sinuses - safer diagnostic method because the patient is not irradiated with x-rays. Therefore, such a procedure can be performed by people with melanoma, women during menstruation or pregnancy.

The main contraindication to MRI of the paranasal sinuses is the presence of metal implants in the patient (pacemakers, endoprostheses, hearing aids in the middle ear, etc.). This is because the magnetic field can damage the implant. If the examination is carried out using computed tomography, then there are no such contraindications.

An innovative study using magnetic resonance imaging reveals most of the known medical science diseases. MRI of the nose and paranasal sinuses is a fairly common study in the diagnosis of ENT pathologies and carries the maximum information about the state of specific anatomical areas for the attending physician.

Sinus Anatomy

The sinuses in the facial region of the human skull are air-filled cavities surrounding the nasal passages from almost all sides. Four pairs of these anatomical structures are connected to the nasal cavity by separate passages, which become conduits for the spread of infection and diseases of a different nature. The paired wedge-shaped cavity is located at the most pronounced distance from the nose, and only magnetic tomography can reveal pathological process.

When to do an MRI

The latest computer test requires strict indications for the appointment, which are taken into account by every doctor. Indications for research usually consist of the following points:

Intensive pain syndrome has the greatest severity in the forehead (according to the patient) - characteristic.
Chronic runny nose has a protracted course, relapses occur rarely and for a short period of time.
and difficulty breathing long time it is not possible to establish and treat in accordance with the etiological factor.
Infectious or allergic cause sinusitis is established, but the treatment does not bring the expected effect, and the process spreads to other sinuses.
Traumatic damage to the nose and sinuses is a separate indication for the MRI procedure. Fresh organ damage is sometimes impossible to determine and establish the amount of therapeutic or surgical care.
MRI of the paranasal sinuses is indicated for the accumulation of blood in the organs in the absence of an established cause, as well as for suspicion of a malignant tumor process in the sinuses.

The technique of the procedure allows you to differentiate many diagnoses and establish primary cause pathology.

Research features

To carry out a magnetic resonance procedure, specific equipment is required in the form of a topographer, on which an examination program is installed. The patient is placed on a horizontal surface that is connected to a closed cylinder chamber. The device produces multiple images of the specified area with high frequency and at different angles, which creates a holistic projection of the anatomical zone.

MRI of the paranasal sinuses is somewhat technologically complex. Scanning here is done with the utmost care, as a large number of mucous membranes, small bones and cartilage makes it difficult to visualize the organs and the features of their condition.

Magnetic tomography can reliably show all the physiological aspects of each organ only if the person does not move. For reliable fixation of the patient, fabric belts are used to avoid even the slightest movement. If even in this state minor convulsions occur, therapy is indicated. sedatives in moderate doses.
The total duration of the procedure usually does not exceed 10 minutes - this is quite enough to confirm or exclude sinusitis.
Research does not bring pain, does not cause disorders of hemodynamics and respiration.
The patient may hear some sound during the scan, which should not be frightening.
In the research room, the potential patient is alone, the medical team watches him through the screen in the next room, while evaluating the issued structure of the organ or anatomical zone.

After the patient finds out what the MRI of the maxillary sinuses showed, he returns to his usual way of life. When a pathology is detected, it is prescribed conservative treatment or the patient is admitted to the hospital.

Interpretation of results

The doctor can evaluate an MRI of the paranasal sinuses on the spot, but he will definitely conduct a detailed interpretation of the images later. positive result is the absence of pathological processes and formations in the study area, while the structure of the sinuses corresponds to the anatomical and physiological parameters.

The study is informative for a number of diseases and disorders:

Tumor processes in the sinuses, even in the early stages of development.
Osteomyelitis of bone structures of the anatomical region.
Foci of the inflammatory process directly in the sinuses or adjacent areas.
Polypous growths, cysts in the sinuses.
Congenital and traumatic violations of the integrity of organs and structural anomalies.

MRI allows you to resolve complex clinical situations with nonspecific symptoms, comorbidities. The study directly of the sinuses of the nose allows you to identify the etiology:

difficult breathing;
increased mucus from the nose;
itching;
burning sensation;
other unpleasant sensations in the nose.

A correct diagnosis allows prescribing etiotropic treatment and formulating an optimistic prognosis for recovery and the absence of relapses.

MRI contraindications

The pathological process shown on MRI is easier to recognize and, as a result, to treat. However, it should be noted that the procedure has some contraindications for use:

Magnetic resonance imaging is not performed on persons whose body contains metal plates or prostheses that are firmly fixed and cannot be removed during the procedure.
The study is not carried out for women at any gestational age, as well as for nursing mothers.
Various invasively placed devices also do not allow examination. This clause applies to innovative insulin pumps, pacemakers, vascular clips, and hearing aids.
Patients with a fear of confined spaces will also find it difficult to carry out the procedure.

For all other groups of patients, tomography is performed successfully with high efficiency.

Magnetic resonance imaging is not the main type of examination of the nasal cavity and paranasal sinuses and is used when other diagnostic methods were not informative enough.

The paranasal sinuses or sinuses are located around the nasal cavity and are bony cavities that are normally filled with air. They are covered with epithelial tissue and serve to humidify and heat the air inhaled by a person, take part in the formation of the voice.

Main indications for MRI of the sinuses:

MRI shows soft tissue lesions: nasal mucosa and paranasal sinuses. The study is not very informative in assessing the state of bone structures. Therefore, in the diagnosis of diseases of the paranasal sinuses, it plays an auxiliary role and is performed with complications of sinusitis or if a cancerous process of the nasal cavity and paranasal sinuses is suspected.

The procedure is also prescribed when other diagnostic measures were not effective or require clarification. The survey is carried out in such situations:

Frequent headache unclear etiology. If, as part of the preliminary diagnosis, it was not possible to determine the diseases of the ENT organs, then it is recommended to conduct an MRI of the paranasal sinuses together with a study of the brain;
There is a suspicion of the development of a benign or malignant neoplasm. The tomograph visualizes the boundaries of the tumor, the degree of its relationship with the paranasal tissues. The type of filling with contrast suggests the nature of the formation;
If within the framework of computed tomography it was possible to determine the presence of changes in the sinuses, but the doctor did not establish their nature. In this case, an MRI of the sinuses will help determine what caused the darkening in the pictures;
Recurrent course of sinusitis, frontal sinusitis, which can be caused by a cyst or polyp. MRI of the paranasal sinuses will help to identify even small formations.

Advantages of the MRI method of the sinuses

MRI of the paranasal space is a painless diagnostic method that allows you to determine even minor deviations in the structure of tissues. The study visualizes well soft tissues, mucous and cartilage, helps to establish the presence of tumors and the location of metastases. The method does not provide negative impact per person, because does not use x-rays and can be performed as often as desired, including to monitor the result of treatment.

It happens that sinusitis is found in patients referred by a neurologist for an MRI of the head with suspected neurological disorders. This diagnosis is not confirmed, while the results point to sinusitis, which could cause headaches.

What does an MRI of the paranasal sinuses show?

During the diagnosis, the tomograph creates a large number of images of the nose area in different planes. The study allows you to identify problems with the nose, such as:

malignant neoplasms of the paranasal sinuses and nasopharynx;
the degree of spread of the tumor to neighboring areas;
benign mucosal formations: polyps, cysts;
development of an abscess from a complication chronic sinusitis;
adenoid growths;
anomalies in the development of the nasopharynx and paranasal sinuses;
the degree of hypertrophic changes in the tonsils and so on.

Using contrast

MRI of the paranasal sinuses can be performed with or without contrast. Gadolinium is widely used as a contrast. The substance is administered parenterally. The use of contrast is necessary if there is a suspicion of the presence of tumors of the nasopharynx and paranasal space, the introduction of a contrast agent improves the possibility of accurately assessing the degree of changes and their differentiation, in other cases - at the discretion of the doctor.

Contraindications for MRI with contrast:

first trimester of pregnancy or breastfeeding;
individual intolerance to the components of the contrast agent;
kidney failure;

MRI (magnetic resonance imaging) of the paranasal sinuses is used as an auxiliary method to detect the pathology of the nose and paranasal sinuses. Usually, radiography or computed tomography. But in some situations, doctors prefer to prescribe an MRI. Especially MRI of the nasal sinuses has proven itself in the study of passages between the nasopharynx and paranasal sinuses, the definition of inflammatory processes and the detection of neoplasms.

What are paranasal sinuses?

The paranasal sinuses are bony cavities that are located around the nose and communicate with the nasal passages. They are covered with a mucous membrane and serve to warm and humidify the air inhaled by a person. In total, 4 pairs of nasal sinuses are distinguished -

Maxillary

Frontal sinuses

Main

Ethmoid sinuses

The largest - the air-bearing maxillary sinuses (maxillary sinuses) - are located in the body upper jaw. The upper wall of the maxillary sinus is also the lower wall of the orbit. The frontal sinuses are located in the frontal bone, and the main sinuses are located in the body sphenoid bone. The ethmoid sinuses are also called the ethmoid labyrinth, as they are represented by air cells of the ethmoid bone located between the frontal and sphenoid sinuses. The study of the nose and sinuses begins with an examination of the nasal passages by an ENT doctor. If the examination is not enough, the doctor prescribes an x-ray, tomography or MRI (link to the main article).

The purpose of MRI diagnostics of the paranasal sinuses

The purpose of MRI of the paranasal sinuses is to identify problems:

In the area of the nasal passages,

In the area of the nasal sinuses

Advantages of MRI examination of the paranasal sinuses.

MRI diagnostics of the nasal sinuses is better than other research methods can determine the inflammatory processes of the mucous membranes or volumetric formations in this area. MRI is a safe procedure, integrity skin and mucous membranes is preserved, and the information content of the method is high.

What does an MRI of the paranasal sinuses reveal?

MRI of the paranasal sinuses can establish any pathology of the nose and sinuses, see the accumulated fluid in the cavities. Especially often, MRI is performed to determine the thickening of the walls of the nasal sinuses and if inflammation is suspected in them. MRI of the sinuses can determine The best way treatment and trace its effectiveness in dynamics in the presence of a tumor or cyst, to identify the degree of spread of metastases. At the same time, MRI is not prescribed if it is necessary to determine the features of the bone structure of the nasal cavity.

Indications for MRI diagnostics of the paranasal sinuses

The doctor directs for an MRI of the paranasal sinuses based on indications such as:

Sudden deterioration of the sense of smell;

Suspicion of a cyst or neoplasm (benign and malignant) of the sinuses;

Suspicious results from other studies,

Headaches of unknown origin (especially in the forehead and temples),

Recurrent nosebleeds,

Discomfort when swallowing, tinnitus or occasional stuffy ears.

Contraindications for MRI of the paranasal sinuses

Contraindications to MRI of the paranasal sinuses, as well as to MRI of other organs and systems, are divided into absolute and relative. You can get acquainted with them in a special section on contraindications to the study (see the corresponding article).

Preparation for MRI of the paranasal sinuses.

MRI of the sinuses does not require special preparation. At the consultation, the doctor will explain to the patient the essence of the procedure, its purpose, and will give recommendations for behavior during the study.

1. Clothing should be comfortable, without zippers and metal buttons and fasteners.

2. Do not use make-up before the examination.

3.Remove watches, clips, earrings, bracelets, hairpins and hair clips, piercing items. Get the keys out of your pockets mobile phone, plastic cards, etc.

If an MRI with contrast is prescribed.

Do not eat anything for 4-5 hours, that is, come on an empty stomach,

Tell your doctor if you are allergic to the contrast agent

Features of the MRI of the paranasal sinuses.

There is a lot of cartilage and bones in the area of the nose and sinuses, so the diagnosis is performed more scrupulously and for a long time.

1. Before an MRI, you need to empty your bladder.

2. During the examination, the patient will be in the supine position. The head can be fixed.

3. During the operation of the scanner, the patient should not move.

4. After the first shots, a contrast agent will be injected intravenously. The patient may experience discomfort in the form of fever, nausea. These phenomena are caused by the introduction of a contrast agent and will soon pass. If the condition worsens, the patient can contact the doctor by pressing a special button.

When making a diagnosis, it is often necessary to undergo quite specific and rare procedures, such as CT and MRI of the nose. Moreover, such manipulations are often quite expensive. They are usually carried out to clarify the diagnosis, as well as to determine the area of the lesion, the degree of involvement different types tissues in pathological processes.

Feature of the diagnostic procedure

CT and MRI of the nose are two procedures that are used to diagnose various pathologies nasopharynx. In terms of information content, they are approximately on the same level, but their security and cost are different.

They differ from x-rays in greater information content, giving an image of a three-dimensional type or sections. At the same time, the condition of soft tissues can also be tracked, which cannot be seen on x-rays.

CT and MRI indications of the nose and sinuses

With the help of these procedures, it is possible to identify a number of diseases, including:

Pathology of the structure;
Diseases of mucous tissues;
Various inflammations of infectious and non-infectious type;
, and others ;
and jaws, if X-ray is contraindicated;

How is it carried out

During the MRI procedure, there is no harmful effect on the human body, since the study is carried out using an absolutely safe electromagnetic field, which shines through the area of study.

The patient is placed in a special apparatus, the area of study is fixed and irradiation is carried out. The obtained data are sent to the computer, where they are displayed as a series of images of the manipulation area in a section step by step. Each step is about 5mm.

A CT scan is similar to an x-ray in many ways. But at the same time, it is less harmful, since a smaller amount of X-ray radiation is used in the process. The patient is placed under a special apparatus that creates x-rays during the examination.

In this case, information is supplied in a more complete volume through the device to the computer in the form of sections of a certain area, made at different angles. In fact, 3D modeling of the study area is carried out, according to which the doctor can study and determine the disease.

How MRI works

Recommendations: how often, is it possible for children, pregnant women, etc.

MRI has no restrictions on the number of procedures performed. But CT, in turn, can be performed no more than 2 times a year due to the fact that it has a small harmful effect on the body, irradiating it. When these methods are not used:

MRI is not used in children who cannot calmly stay in one position for the required period of time;
CT is not performed in an infant, as well as in older children, if they cannot lie still during the procedure;
CT is not performed at;
CT is not performed in breastfeeding women if the process requires the use of a contrast agent;
MRI is not performed in patients who suffer from claustrophobia;
MRI is not used in the presence of electrical devices such as a pacemaker or an insulin pump;

MRI is not performed in the presence of metal parts in the human body - screws, pins, stents and other similar elements.

Deciphering the results

CT is performed in cases where it is necessary to obtain data on neoplasms, structure bone tissue, condition of the sinuses. This method allows more accurate diagnosis. MRI, in turn, helps to track the condition of soft tissues, mucous membranes. With its help, polyposis, tumors, are monitored.

Pictured is an MRI

Contraindications

Contraindications to the CT procedure are:

Pregnancy;
Younger childhood;
on the composition of the contrast agent;
Renal and liver failure;
Heart diseases;
Diabetes;
lactations.

MRI has the following contraindications:

The presence of metal objects in the human body;
The presence of electrical appliances in the patient's body;
Inappropriate behavior of the patient;
Drunk;
The need to provide ongoing resuscitation or monitor the patient's condition with the help of special devices;
Inability to remain stationary.

Price

The price of a CT scan of the nose varies between 2-3 thousand rubles. An MRI can be done for 3.5 thousand rubles. and are correspondingly cheaper. At the same time, they can be carried out according to indications for free, if there is a compulsory medical insurance policy.

Advantages and disadvantages

If we talk about the advantages of procedures in comparison with other methods, then they are:

More informative, as they give a three-dimensional image of the department;
MRI allows you to view soft tissues and neighboring areas;
MRI is completely safe for most patients;
CT can be performed more frequently than x-rays;
MRI in use has no restrictions on the number of times.

If we talk about the cons, then this:

Expensive cost of procedures;
Not every clinic has the appropriate equipment;
It is not always possible to find an institution with such equipment in the city;
CT is more harmful than MRI because it exposes the patient like an x-ray.