Diagnostic accuracy of lateral cephalograms and cone-beam computed tomography for the assessment of sella turcica bridging

Abstract

The purpose of this research was to assess the diagnostic accuracy of sella turcica bridging on lateral cephalograms when compared with true sella turcica bridging determined via cone-beam computed tomography (CBCT). A cross-sectional study was conducted using CBCT images from which lateral cephalograms were generated. The study included 185 subjects (118 females and 67 males; age range, 10-30years; mean age, 16.63±4.20years). Sella turcica landmarks and related measurements were calculated for both diagnostic modalities and analyzed by 1 examiner. Subjects were classified into 1 of 3 outcome groups: no bridging, partial bridging, and complete bridging. Diagnostic accuracy was evaluated using sensitivity, specificity, positive and negative predictive values, and receiver operator characteristic curves. Ten patients were diagnosed as complete bridging on CBCT, whereas 31 patients were diagnosed as complete bridging on lateral cephalogram. Although the lateral cephalogram detected all subjects with complete bridging, it incorrectly classified 12% of subjects. The percent agreement between both diagnostic methods was 55.68%, with a kappa statistic of 0.22 on the right sella turcica and 0.20 on the left sella turcica, indicating fair but statistically significant agreement. The overall accuracy of lateral cephalograms as a diagnostic modality in discriminating between no bridging and partial bridging was good as determined with the area under the curve values of 0.86 and 0.85 for right and left sides, respectively. Although lateral cephalograms overestimate patients with complete bridging compared to CBCTs, they are a suitable screening modality for accurately suggesting complete sella turcica bridging and differentiating between patients with no bridging and partial bridging.