Send to

Choose Destination
J Am Coll Radiol. 2017 Nov;14(11S):S550-S559. doi: 10.1016/j.jacr.2017.08.041.

ACR Appropriateness Criteria® Sinonasal Disease.

Author information

Principal Author and Panel Vice Chair, North Shore-Long Island Jewish Hospital, Hofstra Medical School, Hempstead, New York. Electronic address:
Panel Chair, UC San Diego Health, San Diego, California.
Vanderbilt University Medical Center, Nashville, Tennessee.
Chesapeake Medical Imaging, Annapolis, Maryland.
Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee.
Northwestern Medical Faculty Foundation, Chicago, Illinois; American Academy of Otolaryngology-Head and Neck Surgery.
The Ohio State University Wexner Medical Center, Columbus, Ohio.
Brigham & Women's Hospital & Harvard Medical School, Boston, Massachusetts.
University of Utah, Salt Lake City, Utah.
Mallinckrodt Institute of Radiology, Saint Louis, Missouri.
Saint Louis University Hospital, Saint Louis, Missouri.
UT Southwestern Medical Center, Dallas, Texas.
Colorado Permanente Medical Group, Denver, Colorado.
Specialty Chair, University of Cincinnati Medical Center, Cincinnati, Ohio.


Imaging of sinonasal pathology may occur for assessment of rhinosinusitis or mass lesions. Rhinosinusitis is prevalent in up to 16% of the US population with annual economic burdens estimated at 22 billion dollars. Rhinosinusitis is characterized as acute or chronic based on symptom duration; if four or more episodes occur annually, the term recurrent acute rhinosinusitis (RARS) is used. In acute uncomplicated rhinosinusitis when inflammatory change remains in the paranasal sinuses and nasal cavity, imaging may not be required. Distinction between viral or bacterial rhinosinusitis is a clinical diagnosis, and imaging should be interpreted in conjunction with clinical and endoscopic findings. Sinus CT imaging is appropriate per clinical judgment in associated complications including headache, facial pain, swelling, orbital proptosis, or cranial nerve palsies. In maxillary sinusitis, teeth may require assessment because 20% may be odontogenic in origin. MRI may be complementary in aggressive infections with intraocular/intracranial complications, invasive fungal sinusitis, or sinonasal masses. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.


AUC; Appropriate Use Criteria; Appropriateness Criteria; CT; Fungal nusitis; Intracranial or intraorbital complications; MRI; Nonasal mass; Rhinosinusitis

[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center