Mishra Swastika, Thakur Vijay, Kapila Sumala, Moudgil Sandeep, Mishra Sanat
Department of Radiodiagnosis, IGMC, Shimla, Himachal Pradesh 171001 India.
Department of Intervention Radiology, NIMS University, Jaipur, Rajasthan 303121 India.
Indian J Otolaryngol Head Neck Surg. 2024 Feb;76(1):64-72. doi: 10.1007/s12070-023-04081-w. Epub 2023 Jul 29.
Computed tomography (CT) is the gold standard for diagnosing sinusitis and anatomical variations and a guide for paranasal sinus (PNS) surgeries. High doses of radiation lead to increased risk of head and neck malignancies, radiation-induced cataracts, hypothyroidism, and hyperthyroidism. The purpose of this study was to assess the effectiveness of low-dose CT as compared to standard-dose CT in the identification of anatomical variants of paranasal sinus and rhinosinusitis. This was a prospective cross-sectional study consisting of 72 patients who were divided equally into cases (underwent low-dose CT for PNS) and controls (underwent CT for PNS using standard dose protocols). Prevalence of anatomical variants and sinusitis were compared. Image quality was assessed using volume CT dose index (CTDI), dose length product (DLP), scan length, and noise. Subjective assessment was done by two radiologists, and scores were given. The comparison and analysis of the quantitative and qualitative variables were done. Anatomical variants were comparable among cases and controls, with post-sellar sphenoid being most common and paradoxical middle turbinate being least common surgically important variant. The difference in mean SD of CTDIvol (mGy), DLP (mGy-cm), effective dose (mSv), globe, and air noise between low and standard doses was statistically significant. A moderate agreement (with kappa 0.50) in cases and substantial agreement (with kappa 0.69) in controls was observed between both observers. Low-dose CT PNS and standard-dose CT PNS are comparable in delineating the paranasal sinus anatomy, with a 3.53× reduction of effective radiation dose to patients.
计算机断层扫描（CT）是诊断鼻窦炎和解剖变异的金标准，也是鼻旁窦（PNS）手术的指导方法。高剂量辐射会增加头颈部恶性肿瘤、辐射性白内障、甲状腺功能减退和甲状腺功能亢进的风险。本研究的目的是评估低剂量CT与标准剂量CT在识别鼻旁窦解剖变异和鼻窦炎方面的有效性。这是一项前瞻性横断面研究，由72名患者组成，他们被平均分为病例组（接受低剂量PNS CT扫描）和对照组（接受标准剂量方案的PNS CT扫描）。比较了解剖变异和鼻窦炎的患病率。使用容积CT剂量指数（CTDI）、剂量长度乘积（DLP）、扫描长度和噪声评估图像质量。由两名放射科医生进行主观评估并给出分数。对定量和定性变量进行了比较和分析。病例组和对照组的解剖变异情况具有可比性，蝶鞍后蝶骨是最常见的，而反常中鼻甲是手术中最不常见的重要变异。低剂量和标准剂量之间CTDIvol（mGy）、DLP（mGy-cm）、有效剂量（mSv）、眼球和空气噪声的平均标准差差异具有统计学意义。两位观察者之间在病例组观察到中等一致性（kappa为0.50），在对照组观察到高度一致性（kappa为0.69）。低剂量CT PNS和标准剂量CT PNS在描绘鼻旁窦解剖结构方面具有可比性，可使患者的有效辐射剂量降低3.53倍。
