상악동 병변의 인지시 파노라마 방사선사진의 유용성

Abstract

Purpose: to evaluate the usefulness of the panoramic radiography, generally used in dental clinic, for the detection of the maxillary sinus pathosis due to the inflammation and tumor, through the comparison with CT findings as the absolute standard. Materials & Methods: 150 maxillary sinuses of 75 patients with or without particular signs and symptoms and showing soft tissue lesions or destruction of maxillary sinus walls in at least one sinus in CT, were selected as subject samples, and the panoramic radiography of the same patients were interpretated by 3 dental radiologists and 3 non dental radiologist given no previous informations. Using the CT findings as the absolute standard, the diagnostic ability of panoraimc radiography in the mucosal thickening, maxillary sinus haziness, inferior wall destruction, medial wall destruction, posterolateral wall destruction and the superior wall destruction was evaluated using the ROC curve and the difference between dental radiologist group and non dental radiologist group was also evaluated. Results: 1. When dental radiologist group interpretated the destruction of inferior wall and posterolateral wall, the kappa value which shows interobserver's coincidence was above 0.75. 2. The diagnostic ability according to site of interpretation was the highest when the inferior wall was interpretated in both observer groups and there was a statistically significant difference between the dental radiologist group and non dental radiologist group in interpretating the mucosal thickening, haziness, destruction of the inferior and medial wall(p<0.05). 3. The diagnostic ability in detecting the destruction of the sinus walls was better than in soft tissue lesions in both groups and between the groups there was a statistically significant difference(p<0.05). Conclusion: When detecting the destruction of inferior and posterolateral wall of the maxillary sinus there was coincident with that of CT findings, and so it is considered that diagnostic ability of panoramic radiography is high in this point. But in interpretating the destruction of medial wall and soft tissue lesions, diagnostic ability of the panoramic radiography was relatively low and there was a significant difference between the dental radiologist group and non dental radiologist group. Therefore CT or other auxiliary diagnostic method will be necessary when evaluating thorough pathosis of maxillary sinus objectively.