Sinus MRI scan

Answer 1

Definition

A magnetic resonance imaging (MRI) scan of the sinuses is a noninvasive method to create detailed pictures of the the air-filled spaces inside the skull. These spaces are called the sinuses.

Unlike x-raysand computed tomographic (CT) scans, which use radiation, MRI uses powerful magnets and radio waves. The MRI scanner contains the magnet. The magnetic field produced by an MRI is about 10 thousand times greater than the earth's.

The magnetic field forces hydrogen atoms in the body to line up in a certain way (similar to how the needle on a compass moves when you hold it near a magnet). When radio waves are sent toward the lined-up hydrogen atoms, they bounce back, and a computer records the signal. Different types of tissues send back different signals.

Single MRIimages are called slices. The images can be stored on a computer or printed on film. One exam produces dozens or sometimes hundreds of images.

Alternative Names

MRI of the sinuses; Magnetic resonance imaging - sinuses; Maxillary sinus MRI; Cavernous sinus MRI

How the test is performed

You may be asked to wear a hospital gown or clothing without metal fasteners (such as sweatpants and a t-shirt). Certain types of metal can cause inaccurate images.

You will lie on a narrow table, which slides into the middle of the MRI machine. If you fear confined spaces (have claustrophobia), tell your doctor before the exam. You may be given a medicine to help you feel sleep and less anxious, or your doctor may recommend an "open" MRI, in which the machine is not as close to the body.

Small devices, called coils, are placed around the head. These devices help send and receive the radio waves, and improve the quality of the images.

Some exams require a special dye (contrast). The dye is usually given before the test through a vein (IV) in your hand or forearm. The dye helps the radiologist see certain areas more clearly.

During the MRI, the person who operates the machine will watch you from another room. Several sets of images are usually needed, each taking 2 - 15 minutes. Depending on the type of equipment, the exam may take 1 hour or longer.

How to prepare for the test

You may be asked not to eat or drink anything for 4 - 6 hours before the scan.

Avoid doing a nasal wash within 24 hours before the test is performed.

Before the test, tell the radiologist if you currently undergo dialysis, as this may affect whether you can have IV contrast.

If you fear confined spaces (have claustrophobia), tell your doctor before the exam. You may be given a medicine to help you feel sleepy and less anxious, or your doctor may recommend an "open" MRI, in which the machine is not as close to the body.

The strong magnetic fields created during an MRI can interfere with certain implants, particularly pacemakers. Persons with cardiac pacemakers cannot have an MRI and should not enter an MRI area.

You may not be able to have an MRI if you have any of the following metallic objects in your body:

• Brain aneurysm clips
• Certain artificial heart valves
• Inner ear (cochlear) implants
• Recently placed artificial joints
• Some older types of vascular stents

Tell your health care provider if you have one of these devices when scheduling the test, so the exact type of metal can be determined.

Before an MRI, sheet metal workers or any person that may have been exposed to small metal fragments should receive a skull x-ray to check for metal in the eyes.

Because the MRI contains a magnet, metal-containing objects such as pens, pocketknives, and eyeglasses may fly across the room. This can be dangerous, so they are not allowed into the scanner area.

Other metallic objects are also not allowed into the room:

• Items such as jewelry, watches, credit cards, and hearing aids can be damaged.
• Pins, hairpins, metal zippers, and similar metallic items can distort the images.
• Removable dental work should be taken out just before the scan.

How the test will feel

An MRI exam causes no pain. Some people may become anxious inside the scanner. If you have difficulty lying still or are very anxious, you may be given a mild sedative. Excessive movement can blur MRI images and cause errors.

The table may be hard or cold, but you can request a blanket or pillow. The machine produces loud thumping and humming noises when turned on. You can wear ear plugs to help reduce the noise.

An intercom in the room allows you to speak to the person operating the scanner at any time. Some MRI scanners have televisions and special headphones that you can use to help the time pass.

There is no recovery time, unless you need sedation. After an MRI scan, you can resume your normal diet, activity, and medications.

Why the test is performed

This test provides detailed pictures of the sinuses. Your doctor may order this test if you have:

• Abnormal nasal drainage
• An abnormal finding on an x-ray or nasal endoscopy
• Birth defect of the sinuses
• Loss of smell
• Nasal airway blockage that doesn't get better with treatment
• Repeated bloody noses (epistaxis)
• Signs of injury to the sinus area
• Unexplained headaches
• Unexplained sinus pain that does not get better with treatment

Your doctor may also order this test to:

• Determine if nasal polyps have spread beyond the nose area
• Evaluate an infection or abscess
• Identify a mass or tumor, including cancer
• Plan sinus surgery or monitor your progress after surgery

Normal Values

Results are considered normal if the organs and structures being examined are normal in appearance.

What abnormal results mean

Different types of tissues send back different MRI signals. For example, healthy tissue sends back a slightly different signal than cancerous tissue.

Abnormal results may be due to:

• Blood clot in a sinus (cavernous sinus thrombosis)
• Cancer or tumor
• Infection in the bones of the sinuses (osteomyelitis)
• Infection of the tissues surrounding the eye (orbital cellulitis)
• Nasal polyps
• Sinusitis - acute
• Sinusitis - chronic

Consult your health care provider with any questions and concerns.

What the risks are

MRI uses no ionizing radiation. To date, there have been no documented significant side effects of the magnetic fields and radio waves used on the human body.

The most common type of contrast (dye) used is gadolinium. It is very safe. Allergic reactions to the substance rarely occur. The person operating the machine will monitor your heart rate and breathing.

MRI is usually not recommended for acute trauma situations, because tractionand life-support equipment cannot safely enter the scanner area and the exam can take quite a bit of time.

People have been harmed in MRI machines when they did not remove metal objects from their clothes or when metal objects were left in the room by others.

Special considerations

Tests that may be done instead of a sinus MRI include:

• CT scan of the sinuses
• X-ray of the sinuses

A CT scan may be preferred in emergency cases, since it is faster and usually available right in the emergency room.

Note: MRI is not as effective as CT in defining the anatomy of the sinuses and therefore is not typically used for suspected acute sinusitis.

References

Wilkinson ID, Paley MNJ. Magnetic resonance imaging: basic principles. In: Grainger RC, Allison D, Adam, Dixon AK, eds. Diagnostic Radiology: A Textbook of Medical Imaging. 5th ed. New York, NY: Churchill Livingstone; 2008:chap 5.

O'Handley JG, Tobin E, Tagge B. Otorhinolaryngology. In: Rakel RE. Textbook of Family Medicine. 7th ed. Philadelphia, Pa:Saunders Elsevier; 2007:chap 25.

Rosenfeld RM, Andes D, Bhattacharyya N, Cheung D, Eisenberg S, Ganiats TG, et al. Clinical practice guideline: adult sinusitis. Otolaryngol Head Neck Surg. 2007;137:S1-S31.

Hulett KJ, Stankiewicz JA. Primary sinus surgery. In: Cummings CW, Flint PW, Haughey BH, et al. Otolaryngology:Head and Neck Surgery. 4th ed. Philadelphia, Pa: Mosby Elsevier;2005:chap 53.

Answer 2

Definition

A magnetic resonance imaging (MRI) scan of the sinuses is a noninvasive method to create detailed pictures of the the air-filled spaces inside the skull. These spaces are called the sinuses.

Unlike x-raysand computed tomographic (CT) scans, which use radiation, MRI uses powerful magnets and radio waves. Signals from the magnetic field bounce off your body and are sent to a computer, where they are turned into images. Different types of tissues send back different signals.

Single MRI images are called slices. The images can be stored on a computer or printed on film. One exam produces dozens or sometimes hundreds of images.

Alternative Names

MRI of the sinuses; Magnetic resonance imaging - sinuses; Maxillary sinus MRI

How the test is performed

You may be asked to wear a hospital gown or clothing without metal fasteners (such as sweatpants and a t-shirt). Certain types of metal can cause blurry images.

You will lie on a narrow table, which slides into a tunnel-shaped scanner.

Small devices, called coils, are placed around the head. These devices help improve the quality of the images.

Some exams require a special dye (contrast). The dye is usually given before the test through a vein (IV) in your hand or forearm. The dye helps the radiologist see certain areas more clearly.

During the MRI, the person who operates the machine will watch you from another room. The test most often lasts 30 minutes, but may take longer.

How to prepare for the test

Before the test, tell the radiologist if you are on dialysis, as this may affect whether you can have IV contrast.

If you fear confined spaces (have claustrophobia), tell your doctor before the exam. You may be given a medicine to help you feel sleepy and less anxious, or your doctor may recommend an "open" MRI, in which the machine is not as close to the body.

The strong magnetic fields created during an MRI can interfere with certain implants, particularly pacemakers. Persons with cardiac pacemakers cannot have an MRI and should not enter an MRI area.

You may not be able to have an MRI if you have any of the following metallic objects in your body:

• Brain aneurysm clips
• Certain types of artificial heart valves
• Heart defibrillator or pacemaker
• Inner ear (cochlear) implants
• Recently placed artificial joints
• Certain types of vascular stents
• Pain pumps

Tell your health care provider if you have one of these devices when scheduling the test, so the exact type of metal can be determined.

Before an MRI, sheet metal workers or any person that may have been exposed to small metal fragments should receive a skull x-ray to check for metal in the eyes.

Because the MRI contains a magnet, metal-containing objects such as pens, pocketknives, and eyeglasses may fly across the room. This can be dangerous, so they are not allowed into the scanner area.

Other metallic objects are also not allowed into the room:

• Items such as jewelry, watches, credit cards, and hearing aids can be damaged.
• Pins, hairpins, metal zippers, and similar metallic items can distort the images.
• Removable dental work should be taken out just before the scan.

How the test will feel

An MRI exam causes no pain. Some people may become anxious inside the scanner. If you have difficulty lying still or are very anxious, you may be given a mild sedative. Excessive movement can blur MRI images and cause errors.

The table may be hard or cold, but you can request a blanket or pillow. The machine produces loud thumping and humming noises when turned on. You can wear ear plugs to help reduce the noise.

An intercom in the room allows you to speak to the person operating the scanner at any time. Some MRI scanners have televisions and special headphones that you can use to help the time pass.

There is no recovery time, unless you need sedation. After an MRI scan, you can resume your normal diet, activity, and medications.

Why the test is performed

This test provides detailed pictures of the sinuses. Your doctor may order this test if you have:

• Abnormal nasal drainage
• An abnormal finding on an x-ray or nasal endoscopy
• Birth defect of the sinuses
• Loss of smell
• Nasal airway blockage that doesn't get better with treatment
• Repeated bloody noses (epistaxis)
• Signs of injury to the sinus area
• Unexplained headaches
• Unexplained sinus pain that does not get better with treatment

Your doctor may also order this test to:

• Determine if nasal polyps have spread beyond the nose area
• Evaluate an infection or abscess
• Identify a mass or tumor, including cancer
• Plan sinus surgery or monitor your progress after surgery

Normal Values

Results are considered normal if the organs and structures being examined are normal in appearance.

What abnormal results mean

Different types of tissues send back different MRI signals. For example, healthy tissue sends back a slightly different signal than cancerous tissue.

Abnormal results may be due to:

• Cancer or tumor
• Infection in the bones of the sinuses (osteomyelitis)
• Infection of the tissues surrounding the eye (orbital cellulitis)
• Nasal polyps
• Sinusitis - acute
• Sinusitis - chronic

Consult your health care provider with any questions and concerns.

What the risks are

MRI uses no ionizing radiation. To date, there have been no documented significant side effects of the magnetic fields and radio waves used on the human body.

The most common type of contrast (dye) used is gadolinium. It is very safe. Allergic reactions to the substance rarely occur. The person operating the machine will monitor your heart rate and breathing.

Very rarely people with kidney failure or chronic kidney disease can develop an unusual but serious reaction to the contrast (dye). If you have kidney problems it is important to tell the MRI technologist and health care provider before you get this dye.

MRI is usually not recommended for acute trauma situations, because tractionand life-support equipment cannot safely enter the scanner area and the exam can take quite a bit of time.

People have been harmed in MRI machines when they did not remove metal objects from their clothes or when metal objects were left in the room by others.

Special considerations

Tests that may be done instead of a sinus MRI include:

• CT scan of the sinuses
• X-ray of the sinuses

A CT scan may be preferred in emergency cases, since it is faster and usually available right in the emergency room.

Note: MRI is not as effective as CT in defining the anatomy of the sinuses and therefore is not typically used for suspected acute sinusitis.

References

Wilkinson ID, Paley MNJ. Magnetic resonance imaging: basic principles. In: Grainger RC, Allison D, Adam, Dixon AK, eds. Diagnostic Radiology: A Textbook of Medical Imaging. 5th ed. New York, NY: Churchill Livingstone; 2008:chap 5.

Rosenfeld RM, Andes D, Bhattacharyya N, Cheung D, Eisenberg S, Ganiats TG, et al. Clinical practice guideline: adult sinusitis. Otolaryngol Head Neck Surg. 2007;137:S1-S31.

Aygun N, Zinreich SJ. Radiology of the nasal cavity and paranasal sinuses. In: Cummings CW, Flint PW, Haughey BH, et al, eds. Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2010:chap 44.

Grainger RG, Thomsen HS, Morcos SK, Koh D, Roditi G. Intravascular contrast media for radiology, CT, and MRI. In: Adam A, Dixon AK, eds. Grainger & Allison's Diagnostic Radiology: A Textbook of Medical Imaging. 5th ed. New York, NY: Churchill Livingstone; 2008:chap 2.

Reviewed By

Review Date: 01/31/2011

Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; Jason Levy, MD, Northside Radiology Associates, Atlanta, Georgia. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.