title: Agreement between cone-beam computed tomography and nasoendoscopy evaluations of adenoid hypertrophy.
abstract: BACKGROUND
  The goals of this study were to evaluate (1) the reliability and accuracy of cone-beam computed tomography (CBCT) for assessing adenoid size compared with nasoendoscopy and (2) the influence of clinical experience on CBCT diagnosis.
  
  
  METHODS
  Adenoid size was graded on a 4-point scale for CBCT and nasoendoscopy by a pediatric otolaryngologist. Reliability was assessed with intraobserver and interobserver agreement. Accuracy was assessed with agreement between CBCT and nasoendoscopy, plus sensitivity and specificity analyses. The CBCT assessments were completed by a team of 4 evaluators: an oral and maxillofacial radiologist, an airway orthodontist who participates in the multidisciplinary team, an academic orthodontist whose primary research is in 3-dimensional imaging, and a highly experienced private practice orthodontist comfortable with CBCT imaging. Each evaluator was specifically chosen to represent a unique set of clinical and radiographic experiences. All evaluators were blinded to the subject's identity and clinical history, and they evaluated the images in a unique random order and evaluated each image 3 times separated by a minimum of 7 days. The same computer hardware and software were used.
  
  
  RESULTS
  Thirty-nine consecutively assessed, nonsyndromic subjects (ages, 11.5 ± 2.8 years) were evaluated. The CBCT demonstrated excellent sensitivity (88%) and specificity (93%), strong accuracy (ICC, 0.80; 95% CI, ± 0.15), and good reliability, both within observers (ICC, 0.85; 95% CI, ± 0.08) and between observers (ICC, 0.84; 95% CI, ± 0.08). The clinical experience of the CBCT evaluator did not have a statistically significant effect.
  
  
  CONCLUSIONS
  CBCT is a reliable and accurate tool for identifying adenoid hypertrophy.
authors.affiliation: Associate clinical professor and director of the Inter-disciplinary Airway Clinic, School of Dentistry, University of Alberta, Edmonton, Alberta, Canada. Electronic address: mpmajor@ualberta.ca.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Major
authors.affiliation: Associate clinical professor, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Manisha
authors.initials: M
authors.lastname: Witmans
authors.affiliation: Associate professor, Department of Surgery, Division of Otolaryngology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Hamdy
authors.initials: H
authors.lastname: El-Hakim
authors.affiliation: Professor and chair, School of Dentistry; senior associate dean, Dental Affairs, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Paul W
authors.initials: PW
authors.lastname: Major
authors.affiliation: Associate professor and head of the Division of Orthodontics, School of Dentistry, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Carlos
authors.initials: C
authors.lastname: Flores-Mir
mesh_terms: D000234:Adenoids / Q000000981:diagnostic imaging / Q000473:pathology*; D000293:Adolescent; D000402:Airway Obstruction / Q000000981:diagnostic imaging / Q000473:pathology; D002648:Child; D054893:Cone-Beam Computed Tomography / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D004724:Endoscopy / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D006984:Hypertrophy; D021621:Imaging, Three-Dimensional / Q000706:statistics & numerical data; D008297:Male; D015588:Observer Variation; D009970:Orthodontics / Q000706:statistics & numerical data; D010036:Otolaryngology / Q000706:statistics & numerical data; D011446:Prospective Studies; D011871:Radiology / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity