Definition

A magnetic resonance imaging (MRI) scan of the sinuses creates detailed pictures of the air-filled spaces inside the skull.

These spaces are called the sinuses. The test is noninvasive.

MRI uses powerful magnets and radio waves instead of radiation. Signals from the magnetic field bounce off your body and are sent to a computer. There, they are turned into images. Different types of tissues send back different signals.

Single MRI images are called slices. The images can be stored on a computer or printed on film. One exam produces dozens or sometimes hundreds of images.

Alternative Names

MRI of the sinuses; Magnetic resonance imaging - sinuses; Maxillary sinus MRI

How the Test is Performed

You may be asked to wear a hospital gown or clothing without metal snaps or zippers (such as sweatpants and a t-shirt). Certain types of metal can cause blurry images.

You will lie on a narrow table, which slides into a tunnel-shaped scanner.

Small devices, called coils, are placed around the head. These devices help improve the quality of the images.

Some exams require a special dye (contrast). The dye is usually given before the test through a vein (IV) in your hand or forearm. The dye helps the radiologist see certain areas more clearly.

During the MRI, the person who operates the machine will watch you from another room. The test most often lasts 30 minutes, but may take longer.

How to Prepare for the Test

Before the test, tell the radiologist if you have kidney problems. This may affect whether you can have IV contrast.

If you fear confined spaces (have claustrophobia), tell your health care provider before the exam. You may be given a medicine to help you feel sleepy and less anxious. Your provider may also recommend an "open" MRI, in which the machine is not as close to the body.

The strong magnetic fields created during an MRI can interfere with pacemakers and other implants. People with most cardiac pacemakers cannot have an MRI and should not enter an MRI area. Some newer pacemakers are made that are safe with MRI. You will need to confirm with your provider if your pacemaker is safe in an MRI.

You may not be able to have an MRI if you have any of the following metallic objects in your body:

• Brain aneurysm clips
• Certain types of artificial heart valves
• Heart defibrillator or pacemaker
• Inner ear (cochlear) implants
• Recently placed artificial joints
• Certain types of vascular stents
• Pain pumps

Tell your provider if you have one of these devices when scheduling the test, so the exact type of metal can be determined.

Before an MRI, sheet metal workers or people who may have been exposed to small metal fragments should receive a skull x-ray. This is to check for metal in the eyes.

Because the MRI contains a magnet, metal-containing objects such as pens, pocketknives, and eyeglasses may fly across the room. This can be dangerous, so they are not allowed into the scanner area.

Other metallic objects are also not allowed into the room:

• Items such as jewelry, watches, credit cards, and hearing aids can be damaged.
• Pins, hairpins, metal zippers, and similar metallic items can distort the images.
• Removable dental work should be taken out just before the scan.

How the Test will Feel

An MRI exam causes no pain. Some people may become anxious inside the scanner. If you have problems lying still or are very nervous, you may be given medicine to help you feel calm (sedative). Too much movement can blur MRI images and cause errors.

The table may be hard or cold. You can ask for a blanket or pillow. The machine produces loud thumping and humming noises when turned on. You can wear ear plugs to help reduce the noise.

An intercom in the room lets you speak to the person operating the scanner at any time. Some MRI scanners have televisions and special headphones to help the time pass.

There is no recovery time, unless you need sedation. After an MRI scan, you can go back your normal diet, activity, and medicines.

Why the Test is Performed

This test provides detailed pictures of the sinuses. Your provider may order this test if you have:

• Abnormal nasal drainage
• An abnormal finding on an x-ray or nasal endoscopy
• Birth defect of the sinuses
• Loss of smell
• Nasal airway blockage that does not get better with treatment
• Repeated bloody noses (epistaxis)
• Signs of injury to the sinus area
• Unexplained headaches
• Unexplained sinus pain that does not get better with treatment

Your provider may also order this test to:

• Determine if nasal polyps have spread beyond the nose area
• Evaluate an infection or abscess
• Identify a mass or tumor, including cancer
• Plan sinus surgery or monitor your progress after surgery

Normal Results

Results are considered normal if the organs and structures being examined are normal in appearance.

What Abnormal Results Mean

Different types of tissues send back different MRI signals. Healthy tissue will send back a slightly different signal than cancerous tissue.

Abnormal results may be due to:

• Birth defects
• Bone fractures
• Cancer or tumor
• Infection in the bones of the sinuses (osteomyelitis)
• Infection of the tissues surrounding the eye (orbital cellulitis)
• Nasal polyps
• Sinusitis -- acute
• Sinusitis -- chronic

Talk to your provider if you have questions and concerns.

Risks

MRI uses no ionizing radiation. No side effects from MRI have been reported. The most common type of contrast (dye) used is gadolinium. It is very safe. Allergic reactions to this dye rarely occur. The person operating the machine will monitor your heart rate and breathing.

Very rarely, people with kidney failure or chronic kidney disease can develop a serious reaction to the contrast (dye). If you have kidney problems, it is important to tell the MRI technologist and your provider before you get this dye.

Sinus MRI is usually not recommended for acute trauma situations, because traction and life-support equipment cannot safely enter the scanner area and the exam can take quite a bit of time.

People have been harmed in MRI machines when they did not remove metal objects from their clothes or when metal objects were left in the room by others.

Considerations

Tests that may be done instead of a sinus MRI include:

• CT scan of the sinuses
• X-ray of the sinuses

A CT scan may be preferred in emergency cases, since it is faster and often available in the emergency room.

Note: MRI is not as effective as CT in defining the anatomy of the sinuses, and therefore is not typically used for suspected acute sinusitis.

References

Khan M, Zinreich J, Aygun N. Imaging of the nose and sinuses. In: Flint PW, Francis HW, Haughey BH, et al, eds. Cummings Otolaryngology: Head and Neck Surgery. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 38.

O'Handley JG, Tobin EJ, Shah AR. Otorhinolaryngology. In: Rakel RE, Rakel DP, eds. Textbook of Family Medicine. 9th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 18.

Totonchi A, Armijo B, Guyuron B. Airway issues and the deviated nose. In: Rubin JP, Neligan PC, eds. Plastic Surgery: Volume 2: Aesthetic Surgery. 4th ed. Philadelphia, PA: Elsevier; 2018:chap 18.