Imaging Recommendations for Diagnosis, Staging, and Management of Sinonasal Tumors

Sinonasal tumors are a relatively rare and heterogeneous group of tumors. Owing to their nonspecific presentation and rarity, they can be potentially overlooked resulting in delayed diagnosis and management, and increased patient morbidity. Imaging is crucial for the detection, staging, surgical planning, follow-up as well as surveillance of sinonasal masses, wherein computed tomography (CT) and magnetic resonance imaging (MRI) play complementary roles. CT is better at depicting bony changes, while MRI is useful for delineating the extent of soft tissue lesion, detect perineural, intracranial, or intraorbital spread as well as differentiate trapped sinus secretions from tumor tissue. Other modalities like fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) and arteriography can be selectively employed. FDG-PET is useful for metastatic workup and detection of residual/ recurrent disease. Arteriography and endovascular image-guided interventions are useful to delineate supply of vascular tumors and perform preoperative embolization. A systematic evidence-based approach to a possible case of sinonasal tumor can go a long way in streamlining the detection and management of these tumors, while optimizing the use of available healthcare resources.