Conventional X-ray versus CT in diagnosis of chronic sinusitis in children]

The interpretation of conventional radiographic views for sinusitis in children has given rise to considerable controversy. Thirty-three children (66 sides of sinuses) aged from 4 to 15 years who were suspected of having chronic sinusitis were studied to determine the accuracy of conventional X-ray examination, comparing the results with those of CT. Coronal CT was taken after conventional X-ray examination (Waters and occipito-frontal views), and the time interval between these two examinations was 0 to 14 days (average 5.1 days). The rate of correspondence in diagnosis of sinus pathology between conventional X-ray views and CT was 74.3% in the maxillary sinus and 40.9% in the ethmoid. The rate of overestimation with conventional X-ray views was 24.2% in the maxillary sinus and 56.1% in the ethmoid, while that of underestimation was 1.5% and 3.0% in the maxillary and the ethmoid sinus respectively. The incidence of false positives according to conventional X-ray views was 8.0% in the maxillary sinus and 33.3% in the ethmoid. Our results indicate that Waters view is sufficient to diagnose maxillary sinus pathology in children. However, additional radiologic examinations, such as CT, are necessary in investigating the pathologic conditions of the ethmoid sinus, since diagnostic significance of occipito-frontal view for ethmoid pathology is doubtful in children. A routine preoperative CT is recommended, which allows a detailed evaluation of pathologic changes and anatomical relations of the ethmoid before embarking a surgical intervention for the ethmoid sinus in children.