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Magnetic resonance imaging of carotid artery abnormalities in patients with sphenoid sinusitis
A M Wong1, L T Bilaniuk, R A Zimmerman
1Department of Radiology, Children's Hospital of Philadelphia, 34th Street & Civic Center Boulevard, PA 19104, USA.
Abstract:
Sphenoid sinusitis is unusual in children, but when it occurs, it can lead to serious intracranial complications. We show the value of MRI in demonstrating intracranial abnormalities due to sphenoid sinus infection, particularly those involving the internal carotid arteries and cavernous sinuses. We reviewed our imaging experience of sphenoid sinusitis and found four patients with ICA narrowing who had undergone MR evaluation including conventional and diffusion imaging. MR angiography was also performed in three patients to determine the extent of ICA narrowing. Narrowing of ICA was found in the cavernous segment in all patients and in the supraclinoid segment in three. Cerebral infarction was found in two patients. In one patient the cavernous sinus showed hyperintensity on diffusion-weighted images and hypointensity on apparent diffusion coefficient map, suggesting reduced diffusion. Although infrequent in children, sphenoid sinus infection should be considered as a possible cause of intracranial infection, particularly in teenagers. Early recognition of cavernous sinus involvement and ICA narrowing may lead to prompt treatment and hence a more favorable outcome.
Insights
Sphenoid sinusitis in children can cause serious intracranial issues, particularly affecting the internal carotid arteries. MRI is crucial for detecting these complications early, enabling timely treatment.
Area of Science:
- Radiology
- Neurology
- Pediatrics
Background:
- Sphenoid sinusitis is rare in children but carries a risk of severe intracranial complications.
- Intracranial complications can involve critical neurovascular structures such as the internal carotid arteries and cavernous sinuses.
Observation:
- This study reviewed imaging findings in four pediatric patients with sphenoid sinusitis and internal carotid artery (ICA) narrowing.
- Magnetic Resonance (MR) evaluation, including conventional, diffusion-weighted imaging, and MR angiography, was performed.
- ICA narrowing was consistently observed in the cavernous segment, and in three patients, also in the supraclinoid segment.
Findings:
- Two patients experienced cerebral infarction secondary to the arterial narrowing.
- Diffusion-weighted imaging revealed signs of reduced diffusion in the cavernous sinus of one patient, indicating potential ischemic changes.
Implications:
- Sphenoid sinusitis should be considered in the differential diagnosis of intracranial infections in children, especially adolescents.
- Early detection of cavernous sinus involvement and ICA narrowing via advanced MR imaging is vital.
- Prompt diagnosis and treatment can potentially improve outcomes and prevent severe neurological deficits.
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