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Abstract
Background: Accurate diagnosis of sinusitis is crucial for effective patient management. However, the role of X-ray paranasal sinus (PNS) imaging remains debated when compared to computed tomography (CT) PNS, which is considered the gold standard for sinus evaluation. Previous studies have reported varying levels of sensitivity for X-ray PNS, especially in detecting multi-sinus disease, underscoring the need for updated, region-specific data.
Objective: This study aims to evaluate the diagnostic sensitivity and specificity of X-ray PNS in identifying sinusitis, using CT PNS as the reference standard. The study also seeks to assess the clinical utility of X-ray imaging across different patterns of sinus involvement.
Methods: In this prospective diagnostic accuracy study, 108 adult patients suspected of having sinusitis underwent both X-ray and CT PNS within a 24-hour period. Demographic and clinical information were collected, and the imaging results were independently reviewed by blinded radiologists. Sensitivity, specificity, predictive values, and inter-observer agreement were calculated. Subgroup analyses were performed to evaluate diagnostic performance by sinus region and patient characteristics. A p-value of less than 0.05 was considered statistically significant.
Results: X-ray PNS demonstrated an overall sensitivity of 66.7% and specificity of 47.4%, with the highest sensitivity observed in maxillary sinus disease (75.8%). Sensitivity decreased notably when multiple sinuses were involved. The inter-observer agreement for X-ray interpretation was moderate (kappa=0.31). There was a significant discordance between X-ray and CT results (p=0.018).
Conclusion: X-ray PNS offers moderate sensitivity for detecting sinusitis, particularly for isolated maxillary involvement. However, its performance is limited in cases involving multiple sinuses or non-maxillary regions. CT PNS remains essential for a comprehensive assessment and confirmation of unclear or negative cases