ACR Appropriateness Criteria^® Sinonasal Disease

Area of Science:

• Radiology
• Otolaryngology
• Medical Imaging

Background:

• Rhinosinusitis affects up to 16% of the US population, incurring significant economic costs.
• Imaging for sinonasal pathology is crucial for diagnosing rhinosinusitis and mass lesions.
• Recurrent acute rhinosinusitis (RARS) is defined by four or more annual episodes.

Purpose of the Study:

• To outline evidence-based guidelines for sinonasal imaging.
• To clarify the appropriate use of CT and MRI in diagnosing sinonasal conditions.
• To support clinical decision-making in rhinosinusitis and mass lesion assessment.

Main Methods:

• Review of the American College of Radiology Appropriateness Criteria.
• Analysis of current medical literature from peer-reviewed journals.
• Application of RAND/UCLA Appropriateness Method and GRADE methodology.

Main Results:

• Imaging may not be required for acute uncomplicated rhinosinusitis with limited inflammation.
• CT scans are indicated for complications like facial pain, swelling, or proptosis.
• MRI is valuable for aggressive infections, fungal sinusitis, or sinonasal masses.

Conclusions:

• Imaging interpretation should integrate clinical and endoscopic findings.
• Odontogenic origins should be considered in maxillary sinusitis.
• Expert opinion supplements evidence in guideline development when data is equivocal.