Imaging of mandibular trauma: ROC analysis.
OBJECTIVE
To compare the diagnostic efficacies of panoramic radiographs, mandibular trauma series, and digitized radiographs for detection of fractures of the mandible.


METHODS
Fractures were induced using blunt trauma in 25 cadaver mandibles. Panoramic radiographs, digitized radiographs, and mandibular series comprising an anteroposterior view, two lateral oblique, and a reverse Towne's were used. Six observers recorded their diagnoses using a five-point confidence rating scale. The data were analyzed using receiver operating characteristic (ROC) curve analysis.


RESULTS
Significant differences based on imaging modalities were found (p < 0.0015) in the area under the curves (A(z)): panoramic radiograph, 0.8762; mandibular series, 0.7521; panoramic plus anteroposterior radiographs combination, 0.8886; and digitized mandibular series, 0.7723. No observer-based differences were noted. Condylar and coronoid fractures were difficult to detect than those in other areas of the mandible (p < 0.033). Intra- and inter-observer agreements were high (kappa(w) = 0.81 and 0.76, respectively).


CONCLUSIONS
Panoramic radiographs are adequate for detection of mandibular fractures. Addition of an anteroposterior view augments diagnostic accuracy.
Nair
M K
MK
Oral and Maxillofacial Radiology, University of Pittsburgh, Pittsburgh, PA 15261-1923, USA. mk2n@imap.pitt.edu
Nair
U P
UP
D000704:Analysis of Variance; D002102:Cadaver; D006801:Humans; D008338:Mandibular Injuries / Q000000981:diagnostic imaging*; D015588:Observer Variation; D012372:ROC Curve; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods / Q000592:standards*; D011862:Radiography, Panoramic / Q000379:methods / Q000592:standards*; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*