Assessment of pneumatization of the paranasal sinuses: a comprehensive and validated metric

Michael J Marino; Jacqueline E Weinstein; Charles A Riley; Joshua M Levy; Noah A Emerson; Edward D McCoul

doi:10.1002/alr.21671

Assessment of pneumatization of the paranasal sinuses: a comprehensive and validated metric

Int Forum Allergy Rhinol. 2016 Apr;6(4):429-36. doi: 10.1002/alr.21671. Epub 2015 Dec 1.

Authors

Michael J Marino¹, Jacqueline E Weinstein¹, Charles A Riley¹, Joshua M Levy¹, Noah A Emerson², Edward D McCoul^{1

3}

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, LA.
² Department of Radiology, Ochsner Clinic Foundation, New Orleans, LA.
³ Department of Otorhinolaryngology-Head and Neck Surgery, Ochsner Clinic Foundation, New Orleans, LA.

PMID: 26625267
DOI: 10.1002/alr.21671

Abstract

Background: The purpose of this study was to develop and validate a radiographic metric for characterizing the degree of paranasal sinus pneumatization. A validated metric for the extent of sinus pneumatization that comprehensively includes the maxillary, ethmoid, frontal, and sphenoid cavities is not currently available.

Methods: A validation study was performed in which 5 independent reviewers evaluated 49 sinus computed tomography (CT) scans in coronal, sagittal, and axial orientations. Reviewers evaluated each scan, bilaterally, for 18 proposed dichotomous items as part of the Assessment of Pneumatization of the Paranasal Sinuses (APPS) metric. Evaluation of APPS items was independent of sinus opacification, which was simultaneously evaluated using the standard and validated Lund-Mackay scoring system. Interrater and intrarater reliability was assessed for each proposed APPS parameter and Lund-Mackay item using Fleiss kappa statistic.

Results: Nine parameters were included in the final APPS metric due to substantial interrater reliability (κ(mean) = 0.61, κ(range) = 0.41-0.81) and intrarater consistency (κ(mean) = 0.64, κ(range) = 0.53-0.77), variable radiographic presence, and unique contribution to the characterization of sinus pneumatization. Kappa values were also calculated for Lund-Mackay interrater reliability (κ(mean) = 0.58, κ(range) = 0.45-0.66) and intrarater consistency (κ(mean) = 0.71, κ(range) = 0.65-0.75). The final APPS metric has comparable interrater and intrarater reliability to Lund-Mackay scoring. APPS scores were normally distributed within the study group by Anderson-Darling normality test (p < 0.005).

Conclusion: The APPS score is the first comprehensive and validated metric for quantifying the degree of paranasal sinus pneumatization and anatomic variation. This has important potential utility in standardizing evaluation of sinus CT and researching the relationship of sinus pneumatization with clinical parameters.

Keywords: chronic sinusitis; computed tomography; paranasal sinuses; pneumatization; validation studies.

Publication types

Validation Study

MeSH terms

Adult
Aged
Female
Humans
Male
Middle Aged
Paranasal Sinuses / diagnostic imaging*
Reproducibility of Results
Tomography, X-Ray Computed*