Analysis of the Manifestations of ENT in Low-dose Oral CBCT Examination
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摘要: 目的：探讨锥形束CT在口腔疾病检查中对耳鼻喉相关组织的显示情况及其影像学表现。方法：回顾性分析2019年7月至2020年5月期间医院300例口腔CBCT检查患者资料，统计其牙齿以外周围组织结构的显示情况，解剖结构主要包括鼻窦、鼻腔、咽隐窝、乳突及周围软组织。用双盲法独立评判成像图像中以上组织的解剖显示率（上颌窦、蝶窦、额窦、筛窦），并对组织结构显示情况及组织结构间成像对比度进行评分。所有数据进行统计学分析。结果：口腔CBCT检查中在低剂量X线下能够很好显示鼻窦中的上颌窦及蝶窦，而额窦及筛窦无法显示；鼻腔及咽隐窝显示优良，双侧乳突显示良好；组织间气体、骨质显示好，与软组织、脂肪及液体间评分有显著差异，软组织、脂肪及液体显示不佳，三者间评分无显著差异。结论：低剂量口腔CBCT检查能够很好显示上颌窦、蝶窦、鼻腔及咽隐窝这些耳鼻喉专科相关解剖，在影像结果分析中不要忽视这些组织结构的疾病检出，但是软组织结构间对比度差，这些组织结构疾病的定性诊断还需进一步检查。Abstract: Objective: To investigate the manifestations of ear, nose and throat (ENT) related tissues and imaging manifestations by cone beam computed tomography (CBCT) examination in oral diseases. Methods: The data of 300 patients who underwent oral CBCT examinations in our hospital from July 2019 to May 2020 were retrospectively analyzed, and the display of tissue structures outside their teeth was recorded. Anatomical structures mainly include sinuses, nasal cavity, pharyngeal recesses, mastoid and surrounding soft tissues. The anatomical display rate of the above tissues (maxillary sinus, sphenoid sinus, frontal sinus and ethmoid sinus) in the imaging image was independently evaluated by double-blind method, and the display of tissue structure and the imaging contrast between tissue structures were scored. All data were analyzed statistically, and the results were statistically significant. Results: In oral CBCT, under the low-dose X-ray, the maxillary and sphenoid sinuses in the paranasal sinuses can be well displayed on CBCT, but the frontal and ethmoid sinuses cannot be displayed; nasal cavity and ethmoid sinus pharyngeal crypts got excellent results, and bilateral mastoid got good results. The gas and bone quality between the tissues were displayed well, and the scores between the soft tissue, fat and fluid were significantly different, while the soft tissue, fat and fluid were not displayed well, and there was no significant difference in the scores among the three. Conclusion: Low-dose CBCT in oral examination can well show the relevant anatomy of the maxillary sinus, sphenoid sinus, nasal cavity, and pharyngeal recess. We shouldn’t ignore the disease detection of these tissue structures in the analysis of imaging results, but the contrast between soft tissue structures is poor, the qualitative diagnosis of these tissue structure diseases needs further examination.
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图 1 扫描在最上层图像中出现环形伪影
信噪比评分2分，上颌窦及蝶窦显示清楚评分4分，鼻道及鼻前庭评分2分。
Figure 1. The scan shows a ring artifact in the topside image
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图 2 扫描在最下层图像中出现环形伪影
信噪比评分2分，口咽结构可见，评分2分。
Figure 2. The scan shows a ring artifact in the lowest-side level image
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图 3 CBCT扫描图片
图片信噪比评分4分，双层上颌窦显示优良评分为4分，鼻腔、前庭、鼻咽部显示清楚评分为4分；双侧乳突部分结构显示，显示情况为良好评分3分，气体及骨质显示及对比度评分3分；软组织、脂肪及液体显示及对比度评分1分。
Figure 3. The scanning images of CBCT
表 1 图像SNR及牙齿周围组织结构解剖显示评估
Table 1 Image SNR and evaluation of anatomical display of tissue structure around teeth
项目 A医师 B医师 平均 ≥3分/％ ≤2分/％ Kappa系数 感知信噪比 3.83±0.41 3.79±0.43 4# 98.7～99.0 1.0～1.3 0.754 上颌窦、蝶窦 4 4 4# 100 0 1.000 额窦、筛窦 1 1 1* 0 100 1.000 咽隐窝 3.96±0.27 3.96±0.28 3.96±0.28# 98.7～99.0 1.0～1.3 0.864 鼻腔、前庭 3.99±0.10 3.99±0.12 3.99±0.12# 99.7 0.3 1.000 乳突 2.43±0.69 2.36±0.73 2.40±0.85${}^\nabla $ 46.3～49.3 50.7～53.7 0.820 注：# vs $\nabla $、# vs *、* vs $\nabla $，P<0.05差异有统计学意义；# vs #，P>0.05差异没有统计学意义。 
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表 2 耳鼻喉相关不同密度组织显示及对比度评估
Table 2 Contrast evaluation and display of different density tissues related to ear, nose and throat
项目 A医师 B医师 平均 ≥3分（％） ≤2分（％） Kappa系数 气体 4 4 4# 100 0 1.000 骨质 4 4 4# 100 0 1.000 软组织 0.85±0.36 0.77±0.42 0.81±0.38${}^{\nabla} $ 0 100 0.535 脂肪 1 1 1${}^{\nabla} $ 0 100 1.000 液体 0.81±0.39 0.71±0.46 0.75±0.45${}^{\nabla} $ 0 100 0.543 注：# vs $\nabla $，P<0.05差异有统计学意义；# vs #、$\nabla $ vs $\nabla $，P>0.05差异没有统计学意义。
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