ACR Appropriateness Criteria® Sinonasal Disease: 2021 Update


Mari Hagiwara, Neuroradiology Fellowship Program Director, New York University Langone Health, New York, New York. Electronic address:
Bruno Policeni, Panel Chair, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
Amy F. Juliano, Panel Vice-Chair and Director of Research and Academic Affairs, Mass Eye and Ear, Harvard Medical School, Boston, Massachusetts; ACR Chair NI-RADS Committee.
Mohit Agarwal, Fellowship Program Director, Froedtert Memorial Lutheran Hospital Medical College of Wisconsin, Milwaukee, Wisconsin.
Judah Burns, Residency Program Director, Diagnostic Radiology, Montefiore Medical Center, Bronx, New York.
Prachi Dubey, Houston Methodist Hospital, Houston, Texas; Alternate Councilor, Texas Radiological Society; and Member, ACR Neuroradiology Commission.
Elliott R. Friedman, University of Texas Health Science Center, Houston, Texas.
Maria K. Gule-Monroe, Medical Director of Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Vikas Jain, Assistant Program Director of Radiology Residency Program, MetroHealth Medical Center, Cleveland, Ohio.
Kent Lam, Eastern Virginia Medical School, Norfolk, Virginia; Rhinology and Paranasal Sinus Committee Member, American Academy of Otolaryngology - Head and Neck Surgery; Consultant to the Board, American Rhinologic Society.
Maria Patino, University of Texas Health Science Center, Houston, Texas.
Tanya J. Rath, Division Chair of Neuroradiology, Education Director of Neuroradiology, Mayo Clinic Arizona, Phoenix, Arizona; President of the Eastern Neuroradiological Society.
Brian Shian, Primary Care Physician, University of Iowa Carver College of Medicine, Iowa City, Iowa.
Rathan M. Subramaniam, University of Otago, Dunedin, Otepoti, New Zealand; Co-Chair, ACR Committee on Practice Parameters and Technical Standards - Nuclear Medicine and Molecular Imaging.
M Reza Taheri, Director of Neuroradiology, George Washington University Hospital, Washington, District of Columbia.
David Zander, Chief of Head and Neck Radiology, University of Colorado Denver, Denver, Colorado.
Amanda S. Corey, Specialty Chair, Atlanta VA Health Care System and Emory University, Atlanta, Georgia.

Document Type

Journal Article

Publication Date



Journal of the American College of Radiology : JACR








AUC; Acute sinusitis; Appropriate Use Criteria; Appropriateness Criteria; CSF leak; Chronic sinusitis; Invasive fungal sinusitis; Sinonasal mass


This article presents guidelines for initial imaging utilization in patients presenting with sinonasal disease, including acute rhinosinusitis without and with suspected orbital and intracranial complications, chronic rhinosinusitis, suspected invasive fungal sinusitis, suspected sinonasal mass, and suspected cerebrospinal fluid leak. CT and MRI are the primary imaging modalities used to evaluate patients with sinonasal disease. Given its detailed depiction of bony anatomy, CT can accurately demonstrate the presence of sinonasal disease, bony erosions, and anatomic variants, and is essential for surgical planning. Given its superior soft tissue contrast, MRI can accurately identify clinically suspected intracranial and intraorbital complications, delineate soft tissue extension of tumor and distinguish mass from obstructed secretions.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.