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Aim: The aim of this paper was to evaluate the clinical usefulness of [18F]FDG PET/CT for treatment efficacy assessment in patients with severe multisystemic phenotype of sarcoidosis with special emphasis on sinonasal involvement., Methods: Thirteen patients with biopsy-proven sinonasal sarcoidosis (SNS) who underwent two [18F]FDG-PET/CT were selected. PET/CT results were correlated with nasal endoscopy, biology and conventional imaging techniques (CT, MRI). Four and nine patients underwent first PET/CT before beginning treatment and during CS therapy, respectively. On the other hand, ten and three patients underwent second PET/CT during CS and after treatment withdrawal, respectively. The mean duration of clinical and endoscopic follow-up after the second scintigraphic examination was 51 months., Results: Eleven out of 13 selected patients presented with pathological nasal endoscopy at inclusion. Among them: 1) 5 showed persistent endoscopic abnormalities at follow-up evaluation. Radiological and PET/CT imaging was consistent with these results in 4 and 5 patients, respectively; 2) 2 showed a complete endoscopic, radiologic and PET/CT normalization after CS treatment; 3) 4 showed important alterations of the sinonasal structures preventing a definitive diagnosis by endoscopic and radiologic techniques. PET/CT suggested a residual inflammatory disease in two cases. No scintigraphic abnormalities were detected in the other 2 patients. Scintigraphic results were finally confirmed by a mean follow-up of 51 months. No pathologic sinonasal [18F]FDG uptake was observed in the remaining 2/13 patients who showed doubtful endoscopic and radiologic results during primary evaluation. The stability of endoscopic results without clinical and biological evolution was observed during 39 and 38 months of follow-up after the second PET/CT., Conclusion: [18F]FDG PET/CT seems to be a valuable non-invasive imaging technique able to evaluate the response to treatment in aggressive SNS, identifying persistent active disease even in those patients with destructive sinonasal aftereffects and/or with atypical therapeutic evolution. Finally, [18F]FDG PET/CT could be clinically useful to modulate CS treatment eventually integrating immunosuppressive drugs.

Objectives: Attempt to describe and analyse the radiological and nuclear medicine patterns of sinonasal sarcoidosis (SNS) still poorly reported in the literature., Material and Methods: Retrospective single institution study of 22 consecutive patients with symptomatic biopsy-proven SNS to evaluate the interest of CT, MRI, (67)Ga scintigraphy and (18)F-FDG PET/CT for diagnosis and therapeutic follow-up., Results: Nodules of the septum and turbinates are the most suggestive CT and MRI features. Other CT features such as sinusal filling, mucosal thickening, osteosclerosis or destructive sinonasal lesions are not specific and depend on clinical context and evolutive stage of SNS. (18)F-FDG PET/CT provides complete morphofunctional mapping of active inflammatory sites related to sarcoidosis with a better diagnostic sensitivity (100%) compared to (67)Gallium scintigraphy (75%). The changes in (18)F-FDG uptake intensity could reflect the efficacy of treatment., Conclusion: SNS is an uncommon and probably underdiagnosed phenotype of sarcoidosis. Even if guided biopsy remains necessary for SNS confirmation, medical imaging plays an important role in diagnosis and therapeutic follow-up. CT features with nodules of the septum and/or turbinates are suggestive of SNS contrary to other nonspecific CT findings. CT imaging is directly related severity, reversibility and course of SNS and provide an original radiological staging system in order to predict patient clinical outcome. PET/CT may be used for diagnosis assessement but also to monitor treatment response in a given clinical context, in a patient with histopathologically-proven SNS. Prospective and long term studies are necessary to validate these preliminary results., (Copyright 2009 Elsevier Masson SAS. All rights reserved.)

Purpose: To assess the value of CT for diagnosis and follow-up of AFS. Evaluation of characteristic CT features of AFS., Methods: Retrospective review of 12 cases of AFS presenting with all published diagnostic criteria (1) chronic rhinosinusitis refractory to standard management (2) CT features of chronic sinusitis (3) anatomopathologic, immunoallergologic, biochemical and mycologic criteria. CT findings were correlated with surgical findings and reviewed by one ENT and two radiologists to assess the diagnostic value of different CT features, alone or in association., Results: AFS was isolated in 6 cases, and associated with allergic bronchopulmonary aspergillosis (ABPA) in 6 cases. CT showed pan- or polysinusitis, unilateral or bilateral, with mucosal thickening, sinus opacification frequently heterogeneous, bony changes, fluid trapping, and with pseudotumoral appearance in 3 cases., Conclusion: CT findings alone are not specific or pathognomonic but may suggest AFS in the correct clinical or immunoallergologic setting. It may alert the physician to the need for complementary work-up, exclude the presence of associated lung disease, and better adapt treatment and follow-up.

Purpose: Evaluate the contribution of CT for the diagnosis of caseous fungal and not fungal sinusitis, mostly of dental origin and often improperly called aspergillus sinusitis., Material: and methods. About 50 cases of caseous maxillary sinusitis, including 34 fungal sinusitis, the authors analyse the most important CT criteria. All patients underwent thereafter surgery, and the removal material was submitted to mycological investigations., Results: Constructive and destructive modifications of the bone walls, fillings of sinus cavities and middle meatus are aspecific signs of chronicity. Dental origin foreign bodies and microcalcifications are more evocative but also non specific. Only the mycological investigation leads to the diagnosis of fungal and identifies by round fifty percent cases to the exact nature of fungal., Conclusion: There are no valid predictive criteria for fungal etiology by CT investigation.

CT was performed in three patients with plasmacytoma of the maxilla and mandible. CT allows improved depiction of the tumor and associated local invasion and bony destruction but remains non-specific. Histology is mandatory for diagnosis and work-up necessary to confirm the solitary nature of the lesion. Intraosseous intramedullary lesions often evolve to multiple myeloma after a few years whereas extramedullary lesions, commonly involving sinonasal structures, typically remain solitary.