Diagnostic Efficacy of Digital Waters’ and Caldwell’s Radiographic Views for Evaluation of Sinonasal Area

Objectives: New digital two-dimensional imaging systems are considered as an easily accessible modality for sinonasal evaluation. The aim of this study was to assess the diagnostic efficacy of digital Waters’ and Caldwell’s radiographic views for evaluation of sinonasal area. Materials and Methods: A total of 273 patients fulfilling the inclusion criteria were enrolled in this descriptive-analytical study. Complete opacification or mucosal thickening of frontal, ethmoidal and maxillary sinuses and nasal septum deviation were assessed on digital Waters and Caldwell images. Considering cone beam computed tomography (CBCT) as the gold standard, accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were obtained for the plain films. Results: The sensitivity and specificity for the diagnosis of complete opacification were 89.47% and 95.66% (for frontal sinus), 100% and 97.59% (for ethmoidal air cells), and 100% and 96.42% (for maxillary sinuses), respectively. Regarding mucosal thickening, the sensitivity and specificity were 51.43% and 90.70% (for frontal sinus), 60.84% and 84.80% (for ethmoidal air cells) and 81% and 74.74% (for maxillary sinuses), respectively. The sensitivity of Waters and Caldwell images for detecting nasal septum deviation was 84.31% and 87.25%, respectively; whereas, their specificity was 100%. Conclusions: Digital Caldwell image performs well in detecting frontal and ethmoidal opacification and nasal septum deviation. It has moderate efficacy in assessing frontal and ethmoidal mucosal thickening while it has superior performance for detection of healthy cases. Digital Waters’ view is a reliable modality for maxillary sinus evaluation.