Incidental diagnosis of abnormalities of nasal structures, paranasal sinuses, and mastoid cells on MRI of the head in adult patients with chronic headache

Year 2015, Volume: 4 Issue: 3, 116 - 131, 26.06.2016

İsmail Şalk , Mehmet H Atalar , İsmail Önder Uysal Ali Çetin

Abstract

Abstract

Aim. The purpose of this study to evaluate retrospectively the incidental abnormalities of nasal structures, paranasal sinuses, and mastoid cells on MRI of the head in adult patients with chronic headache. Methods. We collected the presence of abnormalities of nasal structures, paranasal sinuses, and mastoid cells, diagnosed incidentally, from the existing MRI reports by qualified radiologists in a population of 3200 adult patients examined for the differential diagnosis of chronic headache. Results. There were no significant differences among the study groups with regard to the rates of types of chronic sinusitis, mastoiditis, nasal structural abnormalities, and multiple sinusitis (p>0.05). The rates of nasal septum deviation were significantly higher in patients with chronic maxillary and ethmoid sinusitis (p<0.05). The rate of retention cyst was significantly higher in patients with chronic maxillary sinusitis (p<0.05). Conclusions. MRI scans reveal chronic inflammatory changes as chronic paranasal sinusitis and mastoiditis as well as nasal congenital and acquired abnormalities that may be related to sinusitis and mastoiditis in the adult patients. MRI may provide valuable information for otorhinolaryngological and neurological workup of chronic headache in the adult patients, otherwise it is not possible to detect clinically.

Keywords: nasal structures, paranasal sinuses, mastoid cells, magnetic resonance imaging, chronic headache

Özet

Amaç. Bu çalışmanın amacı, kranial MRG yapılmış kronik baş ağrısı olan erişkin hastalarda, nazal yapıların, paranazal sinüslerin ve mastoid hücrelerinin tesadüfen saptanan anormaliklerinin geriye dönük olarak değerlendirilmesidir. Yöntem. Kronik baş ağrısının ayırıcı tanısı için yapılmış olan, nazal yapılarda, paranazal sinüslerde ve mastoid hücrelerinde rastlantısal olarak anormal yapılar saptanan 3200 yetişkin hastanın radyoloji uzmanı tarafından yazılmış MRG raporları toplandı. Bulgular. Mastoidit, nazal yapısal anormallikler, diğer sinüzitlerin birlikteliği ve kronik sinüzit tipinin oranına göre çalışma gruplarının arasında önemli fark yoktu (p>0.05). Nazal septum deviasyonunun oranı, kronik maksiller ve etmoid sinüzitli hastalarda anlamlı olarak yüksek saptandı (p<0.05). Kronik maksiller sinüzitli hastalarda retansiyon kist oranı anlamlı olarak yüksek saptandı (p<0.05). Sonuç. MRG yapılması, kronik paranazal sinüzit ve mastoidit’e ek olarak yetişkin hastalarda sinüzit ve mastoidit ile ilişkili olabilecek doğumsal ve sonradan kazanılan kronik inflamatuvar değişiklikleri gösterir. MRG ile, klinik olarak saptanması zor, kronik baş ağrısı olan yetişkinlerde kulak boğaz burun ve beyin yapıları için önemli bilgiler sağlayabilir.

Anahtar sözcükler: nazal yapılar, paranazal sinüsler, mastoid hücreler, manyetik rezonans görüntüleme, kronik baş ağrısı

References

• Eller M, Goadsby PJ. MRI in headache. Expert Rev Neurother 2013; 13: 263-73.
• Health Quality Ontario. Neuroimaging for the evaluation of chronic headaches: an evidence-based analysis. Ont Health Technol Assess Ser 2010; 10: 1-57.
• Kernick D, Williams S. Should GPs have direct access to neuroradiological investigation when adults present with headache? Br J Gen Pract 2011; 61: 409-11.
• Tsushima Y, Endo K. MR imaging in the evaluation of chronic or recurrent headache. Radiology 2005; 235: 575-9.
• Cull RE. Investigation of late-onset migraine. Scott Med J 1995; 40: 50-2.
• Larson EB, Omenn GS, Lewis H. Diagnostic evaluation of headache. Impact of computerized tomography and cost-effectiveness. JAMA 1980; 243: 359-62.
• Carrera GF, Gerson DE, Schnur J, McNeil BJ. Computed tomography of the brain in patients with headache or temporal lobe epilepsy: findings and cost-effectiveness. J Comput Assist Tomogr 1977; 1: 200- 3.
• Thomas R, Cook A, Main G, Taylor T, Galizia Caruana E, Swingler R. Primary care access to computed tomography for chronic headache. Br J Gen Pract 2010; 60: 426-30.
• Frishberg BM, Rosenberg JH, Matchar DB, McCrory DC, Pietrzak MP, Rozen TD, Silberstein SD, US Headache Consortium. Evidence-based guidelines in the primary care setting: neuroimaging in patients with nonacute headache. Available at: http://www.aan.com/Guidelines/ (accessed in September 2013).
• Hainer BL, Matheson EM. Approach to acute headache in adults. Am Fam Physician 2013; 87: 682-7.
• Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders: 2nd edition. Cephalalgia 2004; 24: 9-160.
• Scottish Intercollegiate Guidelines Network. Diagnosis and management of headache in adults: a national clinical guideline. Edinburgh, ON: SIGN. 2008. [cited: 2010 May 5]. 81 p. No. 107. Available from: www.sign.ac.uk.
• Mechtler LL. Neuroimaging of headaches. Continuum Lifelong Learning Neurol 2008; 14: 94-117.
• Eller M, Goadsby PJ. MRI in headache. Expert Rev Neurother 2013; 13: 263-73.
• Bajwa ZH, Wootton RJ. Evaluation of headache in adults. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA, 2013.
• Goadsby PJ. To scan or not to scan in headache. BMJ 2004; 329: 469- 70.
• Detsky ME, McDonald DR, Baerlocher MO, Tomlinson GA, McCrory DC, Booth CM. Does this patient with headache have a migraine or need neuroimaging? JAMA 2006; 296: 1274-83.
• Simpson GC, Forbes K, Teasdale E, Tyagi A, Santosh C. Impact of GP direct-access computerised tomography for the investigation of chronic daily headache. Br J Gen Pract 2010; 60: 897-901.
• Hopcroft K, Davenport RJ. CT and chronic daily headache. Br J Gen Pract 2011; 61:226.
• Jones NS. Sinus headaches: avoiding over- and mis-diagnosis. Expert Rev Neurother 2009; 9: 439-44.
• Silberstein SD, Rosenberg J. Multispecialty consensus on diagnosis and treatment of headache. Neurology 2000; 54: 1553.
• Silberstein SD. Practice parameter: evidence-based guidelines for migraine headache (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2000; 55: 754-62.
• Brook I. Chronic sinusitis. Available at: http://emedicine.medscape.com. Accessed on: September 2013.
• Maillet M, Bowles WR, McClanahan SL, John MT, Ahmad M. Cone- beam computed tomography evaluation of maxillary sinusitis. J Endod 2011; 37: 753-7.
• Stephens JC, Saleh HA. Evaluation and treatment of isolated maxillary sinus disease. Curr Opin Otolaryngol Head Neck Surg 2013; 21: 50-7.
• Kanagalingam J, Bhatia K, Georgalas C, Fokkens W, Miszkiel K, Lund VJ. Maxillary mucosal cyst is not a manifestation of rhinosinusitis: results of a prospective three-dimensional CT study of ophthalmic patients. Laryngoscope 2009; 119: 8-12.
• Cağlayan F, Tozoğlu U. Incidental findings in the maxillofacial region detected by cone beam CT. Diagn Interv Radiol 2012; 18: 159-63.
• Nazri M, Bux SI, Tengku-Kamalden TF, Ng KH, Sun Z. Incidental detection of sinus mucosal abnormalities on CT and MRI imaging of the head. Quant Imaging Med Surg 2013; 3: 82-8.
• Devan PP. Mastoiditis. Available at: http://emedicine.medscape.com. Accessed on: October 2013.
• Polat S, Aksoy E, Serin GM, Yıldız E, Tanyeri H. Incidental diagnosis of mastoiditis on MRI. Eur Arch Otorhinolaryngol 2011; 268: 1135-8.
• von Kalle T, Fabig-Moritz C, Heumann H, Winkler P. Incidental findings in paranasal sinuses and mastoid cells: a cross-sectional magnetic resonance imaging (MRI) study in a pediatric radiology department. Rofo 2012; 184: 629-34.
• Meredith JR, Boyev KP. Mastoiditis on MRI: fact or artifact? Ear Nose Throat J 2008; 87: 514-8.