Panoramic Radiographs are of Limited Value in the Evaluation of Maxillary Sinus Disease

Publication date: Available online 19 October 2018

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Author(s): Dr Sarah Constantine, Dr Bruce Clark, Dr Andreas Kiermeier, Professor Peter Anderson

ABSTRACT

OBJECTIVES

To determine: 1) the diagnostic efficacy of orthopantomography (OPG) in the diagnosis of sinus diseases, using cone beam CT (CBCT) scanning as the imaging gold standard; 2) which diseases were detected by panoramic radiograph and which required CBCT scanning to make the diagnosis; and 3) the inter-observer agreement of two experienced dental radiologists.

STUDY DESIGN

The images of 714 individuals who underwent orthopantomography (OPG) and CBCT on the same day were assessed separately by two dental radiologists. The results were compared using Gwet's AC1 statistical methods.

RESULTS

In total, 1,322 maxillary sinuses were imaged. The sensitivity of OPG for the detection of any maxillary sinus pathology was poor compared with CBCT, and the specificity was high. The sensitivity of OPG for detecting mucosal thickening was 36.7% compared to CBCT. 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 three-dimensional scanning is necessary for the definitive investigation of sinus lesions.

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