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

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 AC 1 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.

Effectiveness of 2D Radiographs in Detecting CBCT-based Incidental Findings in Orthodontic Patients

“…Constantine et al suggested that panoramic imaging has poor e ciency in nding the problems of maxillary sinuses, presenting a result of 36.7% sensitivity and 51.9% NPV. 27 However, higher sensitivity and NPV of panoramic radiographs were measured in the present study resulting in higher accuracy. Conversely, the accuracy of lateral and postero-anterior cephalograms was signi cantly lower than that of the reference, implying a low diagnostic value of cephalograms for detecting maxillary sinus ndings.…”

Effectiveness of 2D radiographs in detecting CBCT-based incidental findings in orthodontic patients

“…Constantine et al suggested that panoramic imaging has poor efficiency in finding the problems of maxillary sinuses, presenting a result of 36.7% sensitivity and 51.9% NPV 37 . However, higher sensitivity and NPV of the panoramic radiographs were measured in the present study resulting in higher accuracy.…”

Clinicopathological features of 214 maxillary sinus pathologies. A ten-year single-centre retrospective clinical study

“…For this reason, the histopathological study is mandatory. A radiological study must be performed using a CT/CBCT and not a panoramic x-ray since it offers less diagnostic sensitivity [3]. Drumond and Cols [5] performed a study exclusively using a CT in order to evaluate the prevalence of different illnesses in 762 maxillary sinuses.…”

“…For this reason, the histopathological study is mandatory. A radiological study must be performed using a CT/CBCT and not a panoramic x-ray since it offers less diagnostic sensitivity [ 3 ].…”

“…Among the diseases that affect it, anatomical conditions such as aplasia or hypoplasia of the maxillary sinus, non-specific and specific infectious and inflammatory processes, and allergic and tumoral pathologies can be highlighted. Prior to undertaking a surgical intervention on the maxillary sinus and in order to avoid any possible complications, it is very important to evaluate it using diagnostic imaging techniques, by performing a clinical radiological study (CRS) [ 3 ] On many occasions, the histopathological study is fundamental in determining a definitive diagnosis, allowing for a correct therapeutic attitude [ 4 ].…”