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. 2023 Apr 22;13(9):1511.
doi: 10.3390/diagnostics13091511.

Retrospective Analysis of Artifacts in Cone Beam Computed Tomography Images Used to Diagnose Chronic Rhinosinusitis

Niina Kuusisto  1   2 , Jussi Hirvonen  3   4 , Auli Suominen  5 , Stina Syrjänen  1 , Sisko Huumonen  6   7   8 , Pekka Vallittu  9   10 , Ilpo Kinnunen  11
Affiliations

Retrospective Analysis of Artifacts in Cone Beam Computed Tomography Images Used to Diagnose Chronic Rhinosinusitis

Niina Kuusisto et al. Diagnostics (Basel). .

Abstract

Background: Cone beam computed tomography (CBCT) is frequently used to corroborate the signs and symptoms of chronic rhinosinusitis (CRS). However, artifacts induced by dental restorations might complicate the diagnosis of CRS. Here, we assessed the frequency and location of artifacts in CBCT images taken to confirm the CRS.

Methods: All CBCT images of the patients referred to the Emergency Radiology unit, Turku University Hospital, with an indication of CRS in 2017 were re-examined. The prevalence of the artifacts was analyzed in three cross-sectional views and three horizontal levels delimited by anatomical landmarks.

Results: In total, 214 CBCT images of patients with CRS were evaluated. The diagnosis of apical periodontitis (AP) was impaired by artifacts present in 150/214 images (70%). The diagnosis of CRS was impaired in 5 of the 214 images (2.3%). The main origins of the artifacts were large dental fillings or crowns, and endodontic fillings were present in 95% (203/214) and 52% (111/214) of the images, respectively.

Conclusions: AP as an etiology of CRS is possible to miss because of artifacts originating from dental and endodontic fillings in the CBCT images of the paranasal sinuses.

Keywords: apical periodontitis; artifact; cone beam CT; dental restorations; maxilla; rhinosinusitis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Coronal (A) and sagittal (B) view of the CBCT image divided in levels 1–3. 1. The area of the premolar-molar teeth and the alveolar ridge of the maxilla. 2. The area from the maxillary sinus floor to the orbital floor. 3. The area from the orbital floor to the orbital roof.
Figure 2
Figure 2
The coronal (A) and sagittal (B) slices of the CBCT image present sinusitis and distinct apical periodontitis of the root-filled right maxillary molar D16 buccal roots (arrow).
Figure 3
Figure 3
The coronal slice of the CBCT image shows artifacts induced by a metal plate on the right side of the maxilla.
Figure 4
Figure 4
The prevalence of the CBCT images, where artifacts hampered either the evaluation of a given anatomic region or the diagnosis of apical periodontitis (AP) or sinusitis.
Figure 5
Figure 5
The origins of the artifacts.
Figure 6
Figure 6
(Left): The coronal and sagittal CBCT slices present the signs of sinusitis and artifacts induced by dental restorations in the maxilla. Possible apical periodontitis cannot be distinguished accurately because of the artifacts. (Right): The coronal slice of CBCT image presenting mucosal thickening in the paranasal sinuses and artifacts induced by dental restorations hampering the evaluation of the periapical region of the teeth in detail.
Figure 7
Figure 7
The coronal slice of the CBCT image presenting root-filled teeth in the maxilla and some artifacts originating from the fillings.
Figure 8
Figure 8
The axial slice of the CBCT image presents multiple implants causing a substantial amount of artifacts.
See this image and copyright information in PMC

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