The value of Waters' projection for assessing maxillary sinus inflammatory disease.
The value of Waters' projection for assessing maxillary sinus inflammatory disease.
复制标题
Waters 预测对于评估上颌窦炎症性疾病的价值。
DOI：
10.1067/moe.2002.120056
复制
发表时间：
2002
期刊：
影响因子：
--
通讯作者：
A. Vissink
中科院分区：
文献类型：
--
作者：
N. Timmenga;B. Stegenga;G. Raghoebar;Jos van Hoogstraten;R. van Weissenbruch;A. Vissink
目的
沃茨投影对判断上颌骨粘膜疾病的意义至少是值得怀疑的。本研究的目的是评价沃茨上颌窦投影的诊断价值，特别是鼻窦粘膜肿胀作为上颌窦炎的一致性体征。
研究设计
连续40例成人患者因鼻窦区域疼痛、复发性粘液脓性鼻漏和鼻塞或鼻塞至少3个月而被转诊至耳、鼻和咽喉外科医生，对保守治疗无任何反应。记录上颌窦的常规X线片（沃茨投影）和冠状和轴向计算机断层扫描（CT）。常规X线片和CT扫描均在1小时内完成，由2名独立的训练有素的观察员按照鼻窦粘膜肿胀的标准放射诊断标准进行盲法和随机顺序评估。观察者内和观察者间的一致性通过计算Cohen's kappa进行量化。以CT扫描图像为标准，通过计算敏感性、特异性、阳性预测值、似然比和诊断优势比，评价沃茨投影的诊断意义。
结果
沃茨检查的观察者内一致性的Cohen's kappa为0.96，CT扫描的观察者内一致性为0.92。沃茨投影和CT扫描的观察者间一致性分别为0.76和0.92。以CT扫描为标准，沃茨投影诊断上颌窦黏膜肿胀的敏感性为83.3%，特异性为69.2%。沃茨预测的阳性预测（诊断）值为83.3%，阳性似然比为2.7，诊断优势比为11.25。
结论
从这项研究可以得出结论，沃茨的投影不一定排除上颌窦粘膜肿胀的存在。可能需要进行额外的检查，特别是对于鼻窦清除功能受损的患者。
OBJECTIVE
The significance of the Waters' projection for judging maxillary mucosal disease is, at the least, questionable. The aim of this study was to evaluate the diagnostic use of Waters' projection of the maxillary sinus with particular regard to sinus mucosal swelling as a consistent sign of maxillary sinusitis.
STUDY DESIGN
Forty consecutive adult patients were referred to an ear, nose, and throat surgeon for pain in the region of the paranasal sinus, recurrent mucopurulent rhinorrhea, and nasal congestion or obstruction for at least 3 months without any response to conservative treatment. Both conventional radiographs (Waters' projection) and coronal and axial computed tomography (CT) scanning of the maxillary sinuses were recorded. The conventional radiographs and CT scans, all made within an hour, were blinded and assessed in random order by 2 independent well-trained observers with standard radiodiagnostic criteria for sinus mucosal swelling. Intraobserver and interobserver agreements were quantified by calculating Cohen's kappa. The diagnostic significance of the Waters' projection was assessed with the CT scan images as criterion standard by calculating sensitivity and specificity, positive predictive value, likelihood ratio, and diagnostic odds ratio.
RESULTS
Cohen's kappa for the intraobserver agreement of Waters' examination was 0.96, and the intraobserver agreement for CT scanning was 0.92. The interobserver agreement for Waters' projection and CT scanning was 0.76 and 0.92, respectively. With CT scanning as criterion standard, the sensitivity and specificity of Waters' projections to detect maxillary sinus mucosal swelling were 83.3% and 69.2%, respectively. The positive predictive (diagnostic) value of Waters' projections was 83.3%, the positive likelihood ratio 2.7, and the diagnostic odds ratio 11.25.
CONCLUSIONS
From this study it can be concluded that Waters' projections do not necessarily rule out the presence of maxillary sinus mucosal swelling. Additional examinations may be indicated, especially in patients with compromised sinus clearance.