Detection accuracy of maxillary sinus floor septa in panoramic radiographs using CBCT as gold standard: a multi-observer receiver operating characteristic (ROC) study
To investigate diagnostic accuracy of panoramic radiography in detecting maxillary sinus floor septa by means of a multi-observer receiver operating characteristic (ROC) analysis and a standardized protocol for reporting (STARD protocol; Clin Chem 49(1):1–6, 2003).
Material and methods
From our database, 25 cone beam computed tomographies (CBCTs) were selected with one maxillary sinus floor septum (height ≥ 2.5 mm). For the same patient, a recent panoramic radiograph (PAN) had to be available in the database. As controls, 28 CBCTs plus corresponding PANs without evidence of a sinus septum were selected. Using the CBCTs as ground truth, 17 observers from our dental school on a five-point confidence scale rated both sinuses in all 53 PANs with respect to presence/absence of a sinus septum. Areas beneath ROC curves (Az-values), sensitivity/specificity (SNT/SPF), positive/negative predictive values (PPV, NPV), and positive/negative likelihood ratios (LR+, LR−) were computed for each observer and pooled over all observers. Inter-rater reproducibility was assessed by means of the intraclass coefficient (ICC) using a two-way random effects model.
A pooled Az-value of 0.839 was observed (SNT 84.6%, SPF 73.5%). PPV ranged between 0.492 and 0.824 (median 0.627) and NPV between 0.838 and 0.976 (median 0.917). A median LR+ of 3.567 was computed (LR− median 0.193). Inter-rater reliability revealed an ICC of 0.55 (95% confidence interval 0.48 to 0.62).
Our results indicate that PAN is a moderately accurate method for sinus elevation planning for the purpose of septum detection. Ruling out a septum by PAN seems to work more accurately than ruling in.
For the purpose of maxillary sinus floor septa detection, panoramic radiography can be relatively safely advocated, particularly for judgment of a septum-free sinus.
KeywordsMaxillary sinus septa CBCT Diagnostic accuracy Panoramic radiography ROC analysis
The manuscript bases on the thesis of Alexandra Carina Lang entitled “Comparison of accuracy of panoramic versus Cone Beam Computed Tomography radiographs regarding maxillary sinus-floor septa: ROC-analysis.”
The entire study has been solely financed by the University Medical Center of the Johannes Gutenberg-University of Mainz.
Compliance with ethical standards
Conflict of interest
For the submitted work: Both authors declare there were no potential conflicts of interest involved with this research.
Outside the submitted work: Author Ralf Schulze has received a research grant from Sirona Dental Systems GmbH for a different study. Author Ralf Schulze is non-honorarium-based member of several committees of the German Institut of Standardization (DIN) and also of a national technical committee on radiation protection (Arbeitskreis Röntenverordnung, AKRöV). He is also representative for dental radiology and radiation protection for the World Dental Federation (FDI).
As retrospective study using radiographs from an existing database without publication of any patient-related information, no ethical approval is required in our University Medical Center.
Since all the data (radiographic images) used for the study were taken from the existing database and were used in an anonymized fashion, no extra informed consent was required for this type of study. In our center, patients give a general consent that their data in anonymized fashion may be used for scientific study purposes, if their personal data rights and medical confidentiality is adhered.
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