Poor Reproducibility in the Evaluation of Paranasal Sinus X-Rays in Chronic Rhinosinusitis

A Luukkainen,H Huhtala,P Kauppi,S Toppila-Salmi,A Markkola,K Blomgren,M Karjalainen,P Dastidar,M Rautiainen,J Numminen,E Terna,J Jarnstedt

doi:10.4236/ojrad.2017.71003

Abstract

Objective: The aim of this study was to evaluate intra- and inter-observer reproducibility of sinus x-rays in comparison to sinus computed tomography (CT) in chronic rhinosinusitis (CRS) patients. Methods: This was a prospective controlled study for which 14 adult CRS patients were recruited. Patients underwent a sinus multi-detector CT scan as well as additional sinus x-rays at the same time. Symptom interview and skin prick tests were performed. Lund-Mackay (LM) scores and 43 other findings in paranasal sinuses were analyzed by three blinded observers from CT-scans and x-rays. We compared agreement between sinus CT and x-rays (intra-observer reproducibility) and between three observers (inter-observer reproducibility) by Cohen’s kappa. Results: In at least 90% of the cases, the status of 47/49 structures was detectable in CT scans, whereas the status of only 8/49 structures was detectable in x-rays. The majority of the 25 visualized structures had poor intra-observer and inter-observer reproducibility. Conclusion: Only a few structures can be visualized in paranasal sinus x-rays and compared to paranasal sinus CT-scans, their reproducibility is poor. Our results strongly support the current consensus of radiation dose reduction by limiting the number of x-rays.

Highlights

Chronic rhinosinusitis (CRS) is a multifactorial and variable disease with a prevalence of 10.9% [1]
A very small number of structures can be visualized in paranasal sinus x-rays and their evaluation reproducibility is poor compared to paranasal sinus computed tomography (CT) scans
Figure 1. 14 patients diagnosed with chronic rhinosinusitis, who underwent routinely multi-detector sinus computed tomography (CT) scans, were asked to take part in the study and to voluntarily undergo sinus x-rays in three projections at the time CT scans were taken

Summary

Introduction

Chronic rhinosinusitis (CRS) is a multifactorial and variable disease with a prevalence of 10.9% [1]. The main findings of CRS are mucosal changes within the ostiomeatal complex and/or sinuses [1]. Paranasal sinus anatomical variants are very common and several critical anatomical structures (such as big vessels, orbit and central nervous system) are closely located to the sinonasal surgical area [3] [4]. Imaging of the nose and paranasal sinuses has progressed rapidly during the past decade. CT can demonstrate sinus anatomy as well as anatomical variants and other important structures, when preparing for surgery or evaluating the cause of long lasting sinus symptoms. X-rays are not recommended for CRS imaging [2]. X-rays are inferior to CT in detecting bony structures and mucosal changes, little comparative data exists on the agreement between sinus CT and x-rays [2]

Methods

Results

Discussion

Conclusion