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Research ArticlePatient Safety

Dental Flat Panel Conebeam CT in the Evaluation of Patients with Inflammatory Sinonasal Disease: Diagnostic Efficacy and Radiation Dose Savings

C. Leiva-Salinas, L. Flors, P. Gras, F. Más-Estellés, P. Lemercier, J.T. Patrie, M. Wintermark and L. Martí-Bonmatí
American Journal of Neuroradiology November 2014, 35 (11) 2052-2057; DOI: https://doi.org/10.3174/ajnr.A4019
C. Leiva-Salinas
aFrom the Departments of Radiology and Medical Imaging (C.L.-S., L.F., F.M.-E., P.L., L.M.-B.)
eDepartments of Radiology and Medical Imaging (C.L.-S., L.F., M.W.)
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L. Flors
aFrom the Departments of Radiology and Medical Imaging (C.L.-S., L.F., F.M.-E., P.L., L.M.-B.)
eDepartments of Radiology and Medical Imaging (C.L.-S., L.F., M.W.)
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P. Gras
bPhysics (P.G.)
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F. Más-Estellés
aFrom the Departments of Radiology and Medical Imaging (C.L.-S., L.F., F.M.-E., P.L., L.M.-B.)
cERESA (F.M.-E.)
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P. Lemercier
aFrom the Departments of Radiology and Medical Imaging (C.L.-S., L.F., F.M.-E., P.L., L.M.-B.)
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J.T. Patrie
fPublic Health Sciences (J.T.P.), University of Virginia, Charlottesville, Virginia.
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M. Wintermark
eDepartments of Radiology and Medical Imaging (C.L.-S., L.F., M.W.)
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L. Martí-Bonmatí
aFrom the Departments of Radiology and Medical Imaging (C.L.-S., L.F., F.M.-E., P.L., L.M.-B.)
dGIBI Research Group (L.M.-B.), Hospital Universitario y Politécnico la Fe, Valencia, Spain
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    Fig 1.

    A 50-year-old woman with vague facial pain for several months and enophthalmos on physical examination. CT (A) and conebeam CT (B) coronal images show inward retraction of the right maxillary walls and apposition of the right uncinate process into the orbital floor, occluding the maxillary sinus infundibulum. The clinical and CT imaging findings were characteristic of silent sinus syndrome. CT scans delineate anatomic structures and demonstrate disease not shown on the x-ray (C). X-ray shows a small right maxillary sinus but is unable to help in the diagnostic work-up of the patient.

Tables

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    Table 1:

    Image-quality scores for scoring method 1 (visualization of 6 bony anatomic structures) and scoring method 2 (subjective impression of the overall quality of the study) for each imaging technique, with left and right sides combineda

    Standard CTConebeam CTDifference
    Score 1b
        Reader 111 ± 2.8 (3–12)10.5 ± 3.4 (3–12)0.5c
        Reader 211 ± 2.9 (3–12)10.25 ± 3.5 (3–12)0.75d
        Difference00.250.5c
    Score 2e
        Reader 15 ± 0.45 (4–5)4 ± 0.7 (4–5)1d
        Reader 25 ± 0.22 (3–5)4 ± 0.54 (3–5)1d
        Difference000
    • ↵a Data are median values ± SD (range).

    • ↵b Score 1: 0- to 12-point scale.

    • ↵c P < .01.

    • ↵d P < .001.

    • ↵e Score 2: 1- to 5-point scale.

    • View popup
    Table 2:

    Interreader agreement regarding image-quality scores for CT and conebeam CT

    κ Statistics (95% CI)
    CT
        Score 1a0.78 (0.60–0.80)
        Score 2b0.08 (−0.16–0.32)
    Conebeam CT
        Score 1a0.79 (0.70–0.87)
        Score 2b0.40 (0.22–0.59)
    • ↵a Score 1: 0- to 12-point scale.

    • ↵b Score 2: 1- to -5-point scale.

    • View popup
    Table 3:

    Intrareader agreement between CT and conebeam CT image-quality scores for each reader

    κ Statistics (95% CI)
    Reader 1
        Score 1a0.82 (0.75–0.90)
        Score 2b0.03 (−0.05–0.12)
    Reader 2
        Score 1a0.70 (0.60–0.80)
        Score 2b0.01 (−0.00–0.01)
    • ↵a Score 1: 0- to 12-point scale.

    • ↵b Score 2: 1- to 5-point scale.

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    Table 4:

    Image noise, signal-to-noise ratio, and contrast-to-noise ratio for each imaging techniquea

    NoiseSNRbCNR(b/m)CNR(b/a)CNR(m/a)
    CT29.28 ± 9.39100.35 ± 33.197.03 ± 31.63163.80 ± 54.8166.76 ± 23.31
    Conebeam CT46.76 ± 15.8425.33 ± 16.7328.45 ± 18.1150.46 ± 31.922 ± 14
    Difference17.48b75.02b68.58b113.34b44.76b
    • Note:—SNRb indicates SNR of the bone; CNR(b/m), contrast between the bone and the muscle-to-noise ratio; CNR(b/a), contrast between bone and air; CNR(m/a), contrast between muscle and air.

    • ↵a Data are median values ± SD.

    • ↵b P < .001.

    • View popup
    Table 5:

    Absorbed radiation dose to the lenses of the eye and parotid and thyroid glands for each imaging techniquea

    Absorbed Dose Right Lens (mGy)Absorbed Dose Left Lens (mGy)Absorbed Dose Right Parotid Gland (mGy)Absorbed Dose Thyroid Gland (mGy)
    CT9.25 ± 1.699.69 ± 1.088.87 ± 1.680.45 ± 0.13
    Conebeam CT0.28 ± 0.01b0.4 ± 0.03b0.69 ± 0.050.05 ± 0.05
    Difference8.97c9.29c8.18c0.4c
    • ↵a Data are mean values ± SD.

    • ↵b For Conebeam CT, the absorbed radiation dose to the left lens was significantly higher than the dose to the right lens because the x-ray tube describes a 190° rotation around the left side of the patient's face.

    • ↵c P < .001.

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American Journal of Neuroradiology: 35 (11)
American Journal of Neuroradiology
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Cite this article
C. Leiva-Salinas, L. Flors, P. Gras, F. Más-Estellés, P. Lemercier, J.T. Patrie, M. Wintermark, L. Martí-Bonmatí
Dental Flat Panel Conebeam CT in the Evaluation of Patients with Inflammatory Sinonasal Disease: Diagnostic Efficacy and Radiation Dose Savings
American Journal of Neuroradiology Nov 2014, 35 (11) 2052-2057; DOI: 10.3174/ajnr.A4019

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Dental Flat Panel Conebeam CT in the Evaluation of Patients with Inflammatory Sinonasal Disease: Diagnostic Efficacy and Radiation Dose Savings
C. Leiva-Salinas, L. Flors, P. Gras, F. Más-Estellés, P. Lemercier, J.T. Patrie, M. Wintermark, L. Martí-Bonmatí
American Journal of Neuroradiology Nov 2014, 35 (11) 2052-2057; DOI: 10.3174/ajnr.A4019
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