Panoramic radiography is of limited value in the evaluation of maxillary sinus disease

Sarah Constantine; Bruce Clark; Andreas Kiermeier; Professor Peter Anderson

doi:10.1016/j.oooo.2018.10.005

Panoramic radiography is of limited value in the evaluation of maxillary sinus disease

Oral Surg Oral Med Oral Pathol Oral Radiol. 2019 Mar;127(3):237-246. doi: 10.1016/j.oooo.2018.10.005. Epub 2018 Oct 19.

Authors

Sarah Constantine¹, Bruce Clark², Andreas Kiermeier³, Professor Peter Anderson⁴

Affiliations

¹ Clinical Senior Lecturer, University of Adelaide, Faculty of Health Sciences, Adelaide, SA, Australia; South Australian Dental Service, Adelaide Dental Hospital, University of Adelaide Health and Medical Sciences Building, Adelaide, SA, Australia; Queen Elizabeth Hospital, Department of Radiology, Woodville South, SA, Australia; Women's and Children's Hospital, Department of Medical Imaging, North Adelaide, SA, Australia. Electronic address: sconstantine@internode.on.net.
² Retired Craniomaxillofacial Radiologist, Women's and Children's Hospital, Department of Medical Imaging, North Adelaide, SA, Australia.
³ Director, Statistical Process Improvement Consulting and Training Pty Ltd., Statistical Process Improvement Consulting and Training Pty Ltd, Gumeracha, SA, Australia.
⁴ Director of Research, Australian Craniofacial Unit, Women's and Children's Hospital, Australian Craniofacial Unit, Women's and Children's Hospital, North Adelaide, SA, Australia.

PMID: 30477956
DOI: 10.1016/j.oooo.2018.10.005

Abstract

Objectives: The aim of this study was to determine (1) the diagnostic efficacy of orthopantomography (OPG) in the diagnosis of sinus diseases by using cone beam computed tomography (CBCT) as the imaging gold standard, (2) which diseases can be diagnosed by using panoramic radiography or CBCT, and (3) the interobserver agreement of 2 experienced dental radiologists.

Study design: The images of 714 individuals who underwent OPG and CBCT on the same day were assessed separately by 2 dental radiologists. The results were compared by using Gwet's AC₁ statistical methods.

Results: In total, 1322 maxillary sinuses were imaged. The sensitivity of OPG for the detection of any maxillary sinus pathology was poor compared with CBCT, but the specificity was high. The sensitivity of OPG for detecting mucosal thickening was 36.7%. The positive predictive value of OPG for diagnosing mucosal thickening was 79.9 %, but the negative predictive value was 51.9%. Interobserver agreement was strong (≥0.912) for all lesions except mucosal thickening.

Conclusions: Panoramic imaging has low efficacy in the diagnosis of sinus disease, even when examined by experienced dental radiologists. OPG can be useful in excluding disease, but 3-dimensional scanning is necessary for the definitive investigation of sinus lesions.

MeSH terms

Cone-Beam Computed Tomography
Humans
Maxillary Sinus* / diagnostic imaging
Paranasal Sinus Diseases* / diagnostic imaging
Radiography, Panoramic*
Sensitivity and Specificity