Associate clinical professor and director of the Inter-disciplinary Airway Clinic, School of Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Associate clinical professor, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Am J Orthod Dentofacial Orthop. 2014 Oct;146(4):451-9. doi: 10.1016/j.ajodo.2014.06.013.
The goals of this study were to evaluate (1) the reliability and accuracy of cone-beam computed tomography (CBCT) for assessing adenoid size compared with nasoendoscopy and (2) the influence of clinical experience on CBCT diagnosis.
Adenoid size was graded on a 4-point scale for CBCT and nasoendoscopy by a pediatric otolaryngologist. Reliability was assessed with intraobserver and interobserver agreement. Accuracy was assessed with agreement between CBCT and nasoendoscopy, plus sensitivity and specificity analyses. The CBCT assessments were completed by a team of 4 evaluators: an oral and maxillofacial radiologist, an airway orthodontist who participates in the multidisciplinary team, an academic orthodontist whose primary research is in 3-dimensional imaging, and a highly experienced private practice orthodontist comfortable with CBCT imaging. Each evaluator was specifically chosen to represent a unique set of clinical and radiographic experiences. All evaluators were blinded to the subject's identity and clinical history, and they evaluated the images in a unique random order and evaluated each image 3 times separated by a minimum of 7 days. The same computer hardware and software were used.
Thirty-nine consecutively assessed, nonsyndromic subjects (ages, 11.5 ± 2.8 years) were evaluated. The CBCT demonstrated excellent sensitivity (88%) and specificity (93%), strong accuracy (ICC, 0.80; 95% CI, ± 0.15), and good reliability, both within observers (ICC, 0.85; 95% CI, ± 0.08) and between observers (ICC, 0.84; 95% CI, ± 0.08). The clinical experience of the CBCT evaluator did not have a statistically significant effect.
CBCT is a reliable and accurate tool for identifying adenoid hypertrophy.
本研究的目的是评估（1）与鼻内窥镜相比，锥形束 CT（CBCT）评估腺样体大小的可靠性和准确性，以及（2）临床经验对 CBCT 诊断的影响。
由一名儿科耳鼻喉科医生对 CBCT 和鼻内窥镜的腺样体大小进行 4 级评分。通过观察者内和观察者间一致性评估可靠性。通过 CBCT 与鼻内窥镜的一致性评估准确性，并进行敏感性和特异性分析。CBCT 评估由 4 名评估员组成的团队完成：一名口腔颌面放射科医生、一名参与多学科团队的气道正畸医生、一名主要研究 3 维成像的学术正畸医生和一名对 CBCT 成像有丰富经验的私人执业正畸医生。每位评估员都专门代表一组独特的临床和放射学经验。所有评估员均对受检者的身份和临床病史不知情，并以独特的随机顺序评估图像，且每次评估之间至少间隔 7 天。使用相同的计算机硬件和软件。
对 39 例连续评估的非综合征患者（年龄，11.5±2.8 岁）进行了评估。CBCT 显示出良好的敏感性（88%）和特异性（93%）、较高的准确性（ICC，0.80；95%CI，±0.15）和较好的可靠性，观察者内（ICC，0.85；95%CI，±0.08）和观察者间（ICC，0.84；95%CI，±0.08）均如此。CBCT 评估员的临床经验没有统计学显著影响。
CBCT 是一种可靠且准确的工具，可用于识别腺样体肥大。
