Hypointense paranasal sinus foci: differential diagnosis with MR imaging and relation to CT findings

Despite the plethora of information provided by magnetic resonance (MR) imaging that allows differentiation of some substances that are indistinguishable at computed tomography (CT), there are diagnostic problems. In particular, there are several quite disparate substances that all appear as either low signal intensity or signal void on T1-weighted images and even lower signal intensity or signal void on T2-weighted images. These substances include air, desiccated secretion, mycetomas, acute hemorrhage, calcium, bone, and enamel. When they are surrounded by material that has long T1 and T2 relaxation times, a not uncommon MR appearance in the sinonasal cavities, they may be impossible to differentiate from one another. The current explanations for the low signal intensities are presented, the similarities in the MR appearance are illustrated, and the use of CT to resolve diagnostic problems is discussed. CT appears to be the best modality for initially examining patients with suspected routine inflammatory disease or fungal infection.