Optimal CT evaluation for functional endoscopic sinus surgery

PURPOSE: To evaluate the optimal parameters for the CT examination of patients who are having functional endoscopic sinus surgery. METHODS: CT scanning was performed on two fresh cadaveric heads in the direct coronal plane, varying the section thickness, intersection gap, scanner gantry angle, and amperage. The nasal cavity and paranasal sinuses were examined independently in a blinded fashion by four staff neuroradiologists and a staff otolaryngologist with special attention to 10 anatomic landmarks within the ostiomeatal unit that are considered important for preoperative planning. A score of 0 (nonvisualization/incomplete visualization) or 1 (clear/complete visualization) was assigned to each of these 10 landmarks. Analysis of variance was used in which reader, subject, and side were simultaneously controlled by 'blocking.' Multiple comparison methods (ie, Bonferroni) were used to compare the different protocols. RESULTS: We found a significant reduction in the delineation, and therefore the perception, of the ostiomeatal unit structures when the section thickness was greater than 5 mm, any intersection gap was used, and the gantry angle was greater than 10° from the plane perpendicular to the hard palate. However, a reduction in the radiation exposure from 200 mA to 80 mA did not affect the display of the anatomic landmarks. CONCLUSION: We found the optimal screening CT protocol for the paranasal sinuses to be a section thickness of 3 mm, no intersection gap, and a section angle within 10° from the plane perpendicular to the palate. Also, owing to inherent high contrast between air, soft tissue, and bone in the paranasal sinuses, a reduction in the radiation exposure parameter to 80 mA did not affect image quality.