title: How to assess tonsilloliths and styloid chain ossifications on cone beam computed tomography images.
abstract: OBJECTIVE
  The aim of this study was to establish an anatomical guideline in cone beam computed tomography (CBCT) images to discriminate soft-tissue calcifications, specifically, tonsilloliths, and styloid chain ossification (SCO) in the multiplanar reconstruction screen of the i-CAT Vision.
  
  
  METHODS
  We analyzed 100 pairs of CBCT images and panoramic digital radiographies regarding the presence or absence of tonsilloliths and SCO. The intraobserver agreement varied from excellent to good. The statistical analyses included Mann-Whitney test, chi-square test, Spearman test, Student's t-test, and Wilcoxon test. The analyses were repeated without the guideline to verify its effectiveness.
  
  
  RESULTS
  A total of 25 tonsilloliths were found in panoramic images while CBCT images revealed 60. Panoramic and CBCT images showed 42% and 63% of patients positive to SCO, respectively. We found a statistically significant difference when comparing the presence of tonsilloliths and SCO between panoramic and CBCT images (Wilcoxon test P < 0.05). The analyses without the guideline showed that the observer tended to diagnoses more false-positive SCO.
  
  
  CONCLUSIONS
  Based on the results, we can suggest that CBCT images are more suitable to differentiate tonsilloliths and SCO than panoramic images. The guideline was more important to diagnosis SCO than tonsilloliths. SCO was misclassified in 34% without the guideline.
authors.affiliation: Department of Stomatology, Bauru School of Dentistry, University of São Paulo, São Paulo, Brazil.
authors.forename: B S
authors.initials: BS
authors.lastname: Centurion
authors.forename: T S N
authors.initials: TS
authors.lastname: Imada
authors.forename: O
authors.initials: O
authors.lastname: Pagin
authors.forename: A L A
authors.initials: AL
authors.lastname: Capelozza
authors.forename: J R P
authors.initials: JR
authors.lastname: Lauris
authors.forename: I R F
authors.initials: IR
authors.lastname: Rubira-Bullen
mesh_terms: D002114:Calcinosis / Q000000981:diagnostic imaging*; D054893:Cone-Beam Computed Tomography / Q000379:methods*; D003937:Diagnosis, Differential; D006801:Humans; D006928:Hyoid Bone; D008022:Ligaments; D020347:Lithiasis / Q000000981:diagnostic imaging*; D009140:Musculoskeletal Diseases / Q000000981:diagnostic imaging*; D014066:Palatine Tonsil; D010608:Pharyngeal Diseases / Q000000981:diagnostic imaging*; D013701:Temporal Bone
keywords: cone beam computed tomography; guideline; panoramic radiography; physiologic calcification; radiology