Computed tomography assessment of anterior ethmoidal canal dehiscence: An interobserver agreement study and review of the literature

Abstract

Purpose The anterior ethmoidal artery can be injured in functional endoscopic sinus surgery. The ability of computed tomography (CT) to identify dehiscence of the anterior ethmoidal canal (AEC) has not been widely evaluated. The aim of this study was to evaluate the interobserver agreement in the CT assessment of AEC dehiscence. Methods We conducted a retrospective review of consecutive CT scans of the paranasal sinuses (PNS) between January 1, 2012, and December 31, 2012. Two neuroradiologists separately assessed the presence of AEC dehiscence, the presence of PNS opacification, and the best CT plane to evaluate the AEC. Statistical analysis included descriptive analysis and interobserver agreement (kappa coefficient). Results The AEC was below the skull base in 199 (22.3%) cases. Dehiscence of the AEC was found in 13.2% for reader 1 and in 7.3% for reader 2. The interobserver agreement for identification of AEC dehiscence was only fair (κ = 0.246). The interobserver agreement for the AEC dehiscence in cases with opacification of ethmoidal air cells was substantial (κ = 0.754). Conclusion The suboptimal interobserver agreement could potentially limit the usefulness of CT scans for routine assessment of AEC dehiscence. In patients with PNS opacification, CT scans could still add valuable information regarding AEC dehiscence.

Computed tomography assessment of anterior ethmoidal canal dehiscence: methodological issue on interobserver agreement

“…Based on the authors' results, the kappa coefficient for the interobserver agreement identification of AEC dehiscence, the AEC dehiscence in cases with opacification of ethmoidal air cells, the best planes for AEC assessment were k ¼ 0.24, k ¼ 0.75 and k ¼ 0.09, respectively. 1 After reading this article carefully and critically, we have some statistical and methodological concerns to point out, as follow: measuring the reliability of qualitative variables by kappa values has some limitations that we will mention below. First, the kappa value depends on the prevalence in each category.…”

“…CT scans could still add valuable information regarding AEC dehiscence. 1 In this letter, we discuss the correct reporting of reliability and important limitations of applying kappa coefficient to assess reliability. [2][3][4][5][6] Any conclusion in reliability analyses needs to be supported by the methodological and statistical issues mentioned above.…”

“…With deep interest we read the article by Guarnizo and colleagues, which was published in the April 2020 issue of the Neuroradiology Journal . 1 The aim of the authors was to investigate the interobserver agreement in the computed tomography (CT) assessment of the anterior ethmoidal canal (AEC) dehiscence. 1 In 199 patients, the presence of AEC dehiscence, the presence of paranasal sinuses (PNS) opacification and the best CT plane of AEC evaluation were assessed by two neuroradiologists separately.…”

“…1 The aim of the authors was to investigate the interobserver agreement in the computed tomography (CT) assessment of the anterior ethmoidal canal (AEC) dehiscence. 1 In 199 patients, the presence of AEC dehiscence, the presence of paranasal sinuses (PNS) opacification and the best CT plane of AEC evaluation were assessed by two neuroradiologists separately. The kappa coefficient was used to evaluate the interobserver agreement.…”

Reply: “Computed tomography assessment of anterior ethmoidal canal dehiscence: Methodological issue on interobserver agreement”

“…We value the interest of Naderi and Sabour in our work and their knowledgeable comments regarding our article recently published in The Neuroradiology Journal . 1 We appreciate the opportunity to respond to their concerns.…”