Korean J Radiol.  2012 Apr;13(2):136-143. 10.3348/kjr.2012.13.2.136.

Digital Tomosynthesis for PNS Evaluation: Comparisons of Patient Exposure and Image Quality with Plain Radiography

• Yoo JY
• Chung MJ
• Choi B
• Jung HN
• Koo JH
• Bae YA
• Jeon K
• Byun HS
• Lee KS

• KMID: 1245377
• DOI: http://doi.org/10.3348/kjr.2012.13.2.136

Abstract

OBJECTIVE
We investigated low dose digital tomosynthesis (DT) for the evaluation of the paranasal sinus (PNS), and compared its diagnostic accuracy with a PNS radiography series (XR).
MATERIALS AND METHODS
We enrolled 43 patients for whom XR, PNS DT, and OMU CT were performed. We measured effective doses (EDs) of XR, DT, and OMU CT using Monte Carlo simulation software. Two radiologists performed independent observation of both XR and DT. For seven PNSs, they scored anatomic conspicuity of sinuses and confidence on the presence of sinusitis using nine point scales. OMU CT was observed by the third radiologist and the findings were regarded as reference standard. We compared scores for conspicuity and sinusitis confidence between XR and DT.
RESULTS
Mean EDs were 29 +/- 6 microSv, 48 +/- 10 microSv, and 980 +/- 250 microSv, respectively, for XR, DT, and CT. Mean scores for conspicuity were 6.3 and 7.4, respectively, for XR and DT. Sensitivity per patient basis for sinusitis detection were 52% and 96%, respectively, for XR and DT in observer 1 (p = 0.001) and 80% and 92% for observer 2 (p = 0.25). Specificities for sinusitis exclusion were 100% for both XR and DT for observer 1 and 89% and 100% for observer 2 (p = 0.50). Accuracies for sinusitis diagnosis were 72% and 98%, respectively, for XR and DT for observer 1 (p = 0.001) and 84% and 95% for observer 2 (p = 0.125).
CONCLUSION
Patient radiation dose from low dose DT is comparable with that of PNS XR. Diagnostic sensitivity of DT for sinusitis was superior to PNS XR.

Keyword

Tomography, X-Ray; Radiography; Digital; Paranasal sinus disease

MeSH Terms

Adult
Aged
Female
Humans
Male
Middle Aged
Monte Carlo Method
Paranasal Sinuses/*radiography
ROC Curve
Radiation Dosage
Radiographic Image Enhancement/*methods
Sensitivity and Specificity
Sinusitis/*radiography
Statistics, Nonparametric
Tomography, X-Ray Computed/*methods

Figure

• 

  Fig. 1 Scores for anatomic conspicuity for radiography (XR) and digital tomosynthesis (DT) for demarcation of paranasal sinuses. A. For observer 1, mean socres are 5.9 for XR and 6.8 for DT (p < 0.01). B. For observer 2, mean socres are 6.7 for XR and 8.1 for DT (p < 0.01).

• 

  Fig. 2 Images from 65-year-old man with fever. A. Water's view radiograph shows subtle periosteal blurring of right maxillary sinuses. Both observers missed presence of sinusitis. B. Tomosynthesis image shows lobulating mucoperiosteal thickening in right mixillary sinus (arrow) and minimal and smooth thickening in left maxillary sinus (arrowheads). C. CT image confirms presence of mucoperiosteal thickening in both maxillary sinuses.

• 

  Fig. 3 Receiver operator characteristic curve (ROC curve) from radiography (XR) and digital tomosynthesis (DT) for detection of paranasal sinusitis. A. For observer 1, areas under curve (Az) are 0.700 and 0.891, respectively, for XR and DT (p < 0.05). B. For observer 2, Azs are 0.813 and 0.924, respectively, for XR and DT (p < 0.05).

• 

  Fig. 4 Images from 68-year-old woman with cough. A. Water's view radiograph shows subtle fluid filled left maxillary sinus. There is no motion artifact. B. Tomosynthesis image shows image blurring in right maxillary sinus (arrowheads) which mimic mucoperiosteal thickening. Note prominent motion artifact in mandible area. C. CT image confirms presence of left maxillary sinusitis. Note that right maxillary sinus is normal.

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