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Comparison Between Low-Dose and Standard-Dose Multidetector CT in Patients with Suspected Chronic Sinusitis

¹ Department of Radiology, Centre Hospitalier Universitaire de Charleroi, 92 Blvd. Janson, Charleroi B-6000, Belgium.
² Present address: Statistical Unit, Institut de Recherche Interdisciplinaire en Biologie Humaine et Moléculaire, Université Libre de Bruxelles, Brussels B-1070, Belgium.
³ Present address: Department of Radiology, Hôpital Erasme, Université Libre de Bruxelles, Brussels B-1070, Belgium.

View larger version (153K): [in a new window]   Fig. 1A. —Axial multiplanar reformations of multidetector CT (MDCT) scans obtained at level of sphenoethmoidal recess in 35-year-old man who presented with headache suspected to be caused by chronic sinusitis. R = right; a = anterior ethmoid cell; b = basal lamina (arrowhead); p = posterior ethmoid cell. Reformation of low-dose MDCT scan shows normal right (curved arrow) and abnormal left (straight arrow) sphenoethmoidal recess. No discrepancies among reviewers or between pairs of reviewers were noted.

View larger version (134K): [in a new window]   Fig. 1B. —Axial multiplanar reformations of multidetector CT (MDCT) scans obtained at level of sphenoethmoidal recess in 35-year-old man who presented with headache suspected to be caused by chronic sinusitis. R = right; a = anterior ethmoid cell; b = basal lamina (arrowhead); p = posterior ethmoid cell. Reformation of standard-dose MDCT scan shows normal right (curved arrow) and abnormal left (straight arrow) sphenoethmoidal recess. As with A, no discrepancies among reviewers or between pairs of reviewers were noted.

View larger version (126K): [in a new window]   Fig. 2A. —Coronal multiplanar reformations of multidetector CT (MDCT) scans obtained at level of osteomeatal units (straight arrows) in 24-yearold woman who presented with headache suspected to be caused by chronic sinusitis. R = right; m = maxillary sinus; b = right ethmoid bulla. Reformation of low-dose MDCT scan shows abnormal left ethmoid bulla (curved arrow). No discrepancies were noted.

View larger version (127K): [in a new window]   Fig. 2B. —Coronal multiplanar reformations of multidetector CT (MDCT) scans obtained at level of osteomeatal units (straight arrows) in 24-yearold woman who presented with headache suspected to be caused by chronic sinusitis. R = right; m = maxillary sinus; b = right ethmoid bulla. Reformation of standard-dose MDCT scan shows abnormal left ethmoid bulla (curved arrow) seen in A. Discrepancies in findings of ethmoid bulla were noted between first and second interpretation sessions of reviewer 1 and between reviewer 1 and reviewers 2 and 3 in first interpretation session.

View larger version (138K): [in a new window]   Fig. 3A. —Sagittal multiplanar reformations of multidetector CT (MDCT) obtained at level of left maxillary sinus (m) in 52-year-old woman who presented with headache suspected to be caused by chronic sinusitis. Enlarged periodontal space (arrow) was consistently identified throughout all interpretations. P = posterior; f = frontal sinus; m = maxillary sinus. Reformation of low-dose MDCT scan reveals enlarged periodontal space (arrow).

View larger version (127K): [in a new window]   Fig. 3B. —Sagittal multiplanar reformations of multidetector CT (MDCT) obtained at level of left maxillary sinus (m) in 52-year-old woman who presented with headache suspected to be caused by chronic sinusitis. Enlarged periodontal space (arrow) was consistently identified throughout all interpretations. P = posterior; f = frontal sinus; m = maxillary sinus. Reformation of standard-dose MDCT scan reveals enlarged periodontal space (arrow) as clearly as seen in A.

View larger version (155K): [in a new window]   Fig. 4A. —Axial multiplanar reformations of multidetector CT (MDCT) obtained at level of maxillary sinus in 49-year-old man who presented with headache suspected to be caused by chronic sinusitis. Bony remodeling was consistently identified throughout all interpretations. R = right; m = left maxillary sinus. Reformation of low-dose MDCT scan shows osseous lysis (arrow) of anterior wall of right maxillary sinus.

View larger version (150K): [in a new window]   Fig. 4B. —Axial multiplanar reformations of multidetector CT (MDCT) obtained at level of maxillary sinus in 49-year-old man who presented with headache suspected to be caused by chronic sinusitis. Bony remodeling was consistently identified throughout all interpretations. R = right; m = left maxillary sinus. Reformation of standard-dose MDCT scan reveals osseous lysis (arrow) of anterior wall of right maxillary sinus as clearly as seen in A.

View larger version (12K): [in a new window]   Fig. 5. —Graphs representing mean (± SEM) number of discrepancies in identifying abnormalities of sphenoethmoidal recess (Fig. 5), osteomeatal unit (Fig. 6), nasofrontal duct (Fig. 7), and ethmoid bulla (Fig. 8). X-axis represents sets of comparisons: 1, two-by-two comparisons between pairs of reviewers at both sessions interpreting low-dose multidetector CT (MDCT) scans; 2, two-by-two comparisons between pairs of reviewers at both sessions interpreting standard-dose MDCT scans; 3, intrareviewer comparisons between two interpretation sessions of low-dose MDCT scans; 4, intrareviewer comparisons between two interpretation sessions of standard-dose MDCT scans; 5, comparisons between interpretations of low- and standard-dose MDCT scans for each reviewer and for both interpretation sessions. In cases of statistically significant discrepancies, p values from Tukey tests [24] are given. Solid line represents significant difference involving comparisons of low-dose and standard-dose scans among reviewers. Dashed line represents significant difference involving another comparison. Vertical bars extending on either side of mean point represent range.

View larger version (12K): [in a new window]   Fig. 6. —Graphs representing mean (± SEM) number of discrepancies in identifying abnormalities of sphenoethmoidal recess (Fig. 5), osteomeatal unit (Fig. 6), nasofrontal duct (Fig. 7), and ethmoid bulla (Fig. 8). X-axis represents sets of comparisons: 1, two-by-two comparisons between pairs of reviewers at both sessions interpreting low-dose multidetector CT (MDCT) scans; 2, two-by-two comparisons between pairs of reviewers at both sessions interpreting standard-dose MDCT scans; 3, intrareviewer comparisons between two interpretation sessions of low-dose MDCT scans; 4, intrareviewer comparisons between two interpretation sessions of standard-dose MDCT scans; 5, comparisons between interpretations of low- and standard-dose MDCT scans for each reviewer and for both interpretation sessions. In cases of statistically significant discrepancies, p values from Tukey tests [24] are given. Solid line represents significant difference involving comparisons of low-dose and standard-dose scans among reviewers. Dashed line represents significant difference involving another comparison. Vertical bars extending on either side of mean point represent range.

View larger version (11K): [in a new window]   Fig. 7. —Graphs representing mean (± SEM) number of discrepancies in identifying abnormalities of sphenoethmoidal recess (Fig. 5), osteomeatal unit (Fig. 6), nasofrontal duct (Fig. 7), and ethmoid bulla (Fig. 8). X-axis represents sets of comparisons: 1, two-by-two comparisons between pairs of reviewers at both sessions interpreting low-dose multidetector CT (MDCT) scans; 2, two-by-two comparisons between pairs of reviewers at both sessions interpreting standard-dose MDCT scans; 3, intrareviewer comparisons between two interpretation sessions of low-dose MDCT scans; 4, intrareviewer comparisons between two interpretation sessions of standard-dose MDCT scans; 5, comparisons between interpretations of low- and standard-dose MDCT scans for each reviewer and for both interpretation sessions. In cases of statistically significant discrepancies, p values from Tukey tests [24] are given. Solid line represents significant difference involving comparisons of low-dose and standard-dose scans among reviewers. Dashed line represents significant difference involving another comparison. Vertical bars extending on either side of mean point represent range.

View larger version (14K): [in a new window]   Fig. 8. —Graphs representing mean (± SEM) number of discrepancies in identifying abnormalities of sphenoethmoidal recess (Fig. 5), osteomeatal unit (Fig. 6), nasofrontal duct (Fig. 7), and ethmoid bulla (Fig. 8). X-axis represents sets of comparisons: 1, two-by-two comparisons between pairs of reviewers at both sessions interpreting low-dose multidetector CT (MDCT) scans; 2, two-by-two comparisons between pairs of reviewers at both sessions interpreting standard-dose MDCT scans; 3, intrareviewer comparisons between two interpretation sessions of low-dose MDCT scans; 4, intrareviewer comparisons between two interpretation sessions of standard-dose MDCT scans; 5, comparisons between interpretations of low- and standard-dose MDCT scans for each reviewer and for both interpretation sessions. In cases of statistically significant discrepancies, p values from Tukey tests [24] are given. Solid line represents significant difference involving comparisons of low-dose and standard-dose scans among reviewers. Dashed line represents significant difference involving another comparison. Vertical bars extending on either side of mean point represent range.

View larger version (13K): [in a new window]   Fig. 9. —Graphs representing mean (± SEM) number of discrepancies in identifying abnormalities of posterior ethmoid cells (Fig. 9), basal lamina (Fig. 10), and periodontal space (Fig. 11). X-axis represents sets of comparisons: 1, two-by-two comparisons between pairs of reviewers at both sessions interpreting low-dose multidetector CT (MDCT) scans; 2, two-by-two comparisons between pairs of reviewers at both sessions interpreting standard-dose MDCT scans; 3, intrareviewer comparisons between two interpretation sessions of low-dose MDCT scans; 4, intrareviewer comparisons between two interpretation sessions of standard-dose MDCT scans; 5, comparisons between interpretations of low- and standard-dose MDCT scans for each reviewer and for both interpretation sessions. In cases of statistically significant discrepancies, p values from Tukey tests [24] are given. Solid line represents significant difference involving comparisons of low-dose and standard-dose scans among reviewers. Dashed line represents significant difference involving another comparison. Vertical bars extending on either side of mean point represent range.

View larger version (11K): [in a new window]   Fig. 10. —Graphs representing mean (± SEM) number of discrepancies in identifying abnormalities of posterior ethmoid cells (Fig. 9), basal lamina (Fig. 10), and periodontal space (Fig. 11). X-axis represents sets of comparisons: 1, two-by-two comparisons between pairs of reviewers at both sessions interpreting low-dose multidetector CT (MDCT) scans; 2, two-by-two comparisons between pairs of reviewers at both sessions interpreting standard-dose MDCT scans; 3, intrareviewer comparisons between two interpretation sessions of low-dose MDCT scans; 4, intrareviewer comparisons between two interpretation sessions of standard-dose MDCT scans; 5, comparisons between interpretations of low- and standard-dose MDCT scans for each reviewer and for both interpretation sessions. In cases of statistically significant discrepancies, p values from Tukey tests [24] are given. Solid line represents significant difference involving comparisons of low-dose and standard-dose scans among reviewers. Dashed line represents significant difference involving another comparison. Vertical bars extending on either side of mean point represent range.

View larger version (13K): [in a new window]   Fig. 11. —Graphs representing mean (± SEM) number of discrepancies in identifying abnormalities of posterior ethmoid cells (Fig. 9), basal lamina (Fig. 10), and periodontal space (Fig. 11). X-axis represents sets of comparisons: 1, two-by-two comparisons between pairs of reviewers at both sessions interpreting low-dose multidetector CT (MDCT) scans; 2, two-by-two comparisons between pairs of reviewers at both sessions interpreting standard-dose MDCT scans; 3, intrareviewer comparisons between two interpretation sessions of low-dose MDCT scans; 4, intrareviewer comparisons between two interpretation sessions of standard-dose MDCT scans; 5, comparisons between interpretations of low- and standard-dose MDCT scans for each reviewer and for both interpretation sessions. In cases of statistically significant discrepancies, p values from Tukey tests [24] are given. Solid line represents significant difference involving comparisons of low-dose and standard-dose scans among reviewers. Dashed line represents significant difference involving another comparison. Vertical bars extending on either side of mean point represent range.

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