Pachêco-Pereira Camila, Alsufyani Noura, Major Michael, Palomino-Gómez Sandra, Pereira José Roberto, Flores-Mir Carlos
School of Dentistry, Faculty of Medicine and Dentistry, School of Dentistry, University of Alberta, Edmonton, Alberta, Canada.
School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; College of Dentistry, King Saud University, Riyadh, Saudi Arabia.
Am J Orthod Dentofacial Orthop. 2017 Jul;152(1):92-103. doi: 10.1016/j.ajodo.2016.11.024.
The aim of this study was to evaluate the diagnostic correlation and reliability of Dolphin Imaging fully automated segmentation (Dolphin Imaging and Management Solutions, Chatsworth, Calif) for assessing adenoid hypertrophy. This was investigated through 3 modes: (1) intraobserver and interobserver agreement of repeated airway auto-segmentation procedures, (2) correlation between auto-segmentation measures of volume and minimal cross-sectional airway against nasopharyngoscopy, and (3) optimum diagnostic cutoff thresholds for volume and minimal cross-sectional airway identified and tested with sensitivity and specificity analyses.
Cone-beam computed tomography scans of 38 patients with suspected upper airway obstruction were analyzed. Two calibrated evaluators applied a previously validated method to quantify nasopharyngeal minimal cross-sectional airway and volume using Dolphin Imaging. Assessments were compared against grades of obstruction provided by otolaryngologists' diagnoses.
The reliability between the 2 assessments by the same evaluator on the Dolphin automatic segmentation function for volume (ICC, 0.97; 95% CI, 0.95, 0.98) and minimal cross-sectional airway (ICC, 0.84; 95% CI, 0.69, 0.91) was excellent. The interoperator reliability for volume was also excellent (ICC, 0.97; 95% CI, 0.95, 0.98), but only good (ICC, 0.701; 95% CI, 0.44, 0.85) for minimal cross-sectional airway. In contrast, the Spearman rank correlation test demonstrated weak associations between the values of the automatic measurements for both volume (4.9%; ρ = -0.22) and minimal cross-sectional airway (3.7%; ρ = 0.19). Assessments of accuracy via Receiver Operating characteristic analysis, sensitivity, specificity, negative predictive values, positive predictive values, and likelihood ratios demonstrated the poor clinical applicability of volume and minimal cross-sectional airway numbers provided by Dolphin Imaging.
The evaluators were reliable at manipulating the selected software, achieving consistent volume and minimal cross-sectional airway measurements, However, Dolphin Imaging volumetric and minimal cross-sectional airway measurements did not correlate well with the nasopharyngoscopy-supported reference standard for adenoid hypertrophy assessment. Under these study conditions, volume and minimal cross-sectional airway used to assess localized adenoid hypertrophy with cone-beam computed tomography imaging based on automated measurements may not yield high-quality clinically relevant information about upper airway constriction related to adenoid hypertrophy.
本研究旨在评估Dolphin Imaging全自动分割技术（Dolphin Imaging and Management Solutions，加利福尼亚州查茨沃思）在评估腺样体肥大方面的诊断相关性和可靠性。通过三种模式进行了研究：（1）重复气道自动分割程序的观察者内和观察者间一致性；（2）自动分割的体积测量值和最小气道横截面积测量值与鼻咽镜检查结果之间的相关性；（3）确定并通过敏感性和特异性分析测试体积和最小气道横截面积的最佳诊断截断阈值。
对38例疑似上气道阻塞患者的锥形束计算机断层扫描进行分析。两名经过校准的评估者采用一种先前经验证的方法，使用Dolphin Imaging技术对鼻咽部最小气道横截面积和体积进行量化。将评估结果与耳鼻喉科医生诊断提供的阻塞分级进行比较。
同一名评估者对Dolphin自动分割功能的体积测量值（组内相关系数[ICC]，0.97；95%可信区间[CI]，0.95，0.98）和最小气道横截面积测量值（ICC，0.84；95%CI，0.69，0.91）进行的两次评估之间的可靠性极佳。体积测量值的操作者间可靠性也极佳（ICC，0.97；95%CI，0.95，0.98），但最小气道横截面积测量值的可靠性仅为良好（ICC，0.701；95%CI，0.44，0.85）。相比之下，Spearman等级相关检验表明，体积测量值（4.9%；ρ = -0.22）和最小气道横截面积测量值（3.7%；ρ = 0.19）的自动测量值之间的相关性较弱。通过受试者操作特征分析、敏感性、特异性、阴性预测值、阳性预测值和似然比进行的准确性评估表明，Dolphin Imaging提供的体积和最小气道横截面积数值的临床适用性较差。
评估者在操作所选软件方面具有可靠性，能够获得一致的体积和最小气道横截面积测量值。然而，Dolphin Imaging的体积测量值和最小气道横截面积测量值与用于腺样体肥大评估的鼻咽镜检查支持的参考标准相关性不佳。在这些研究条件下，基于自动测量的锥形束计算机断层扫描成像中用于评估局限性腺样体肥大的体积和最小气道横截面积，可能无法产生有关与腺样体肥大相关的上气道狭窄的高质量临床相关信息。
