Agreement between Panoramic Radiography and CBCT in Interpretation and Diagnosis of Jaw Lesions

Objective: this study aims to assess the rate of agreement between panoramic radiography (PR) and CBCT in evaluating the radiographic features of intraosseous lesions and detecting whether these differences had a significant impact on the accuracy of differential diagnoses. Methods: Twenty four (24) intraosseous biopsy-proven lesions were reviewed using PR and CBCT images by two oral and maxillofacial radiologists. Both observers answered eighteen questions for each case describing the lesions` radiographic criteria and listed two possible differential diagnoses for each case. Results: McNemar’s test was used for comparing the two modalities and for calculating the inter-observer agreement. The intra-observer agreement showed that questions 18 (cortical destruction) and 10 (expansion in the anatomical landmarks) had the lowest percentage of agreement between both observers. Furthermore, there was no statistically significant difference between the two modalities in terms of the agreement between differential diagnosis and final diagnosis (P > 0.05). Conclusions: Both PR and CBCT provide similar agreement in describing the lesion location, epicenter, internal structure. Moreover, similar agreement was also observed regarding the effect of the lesion on the teeth including resorption, impaction and displacement, root resorption, lamina dura, and periodontal membrane space of the teeth. The main disagreement between the two modalities was found in the expansion of the normal surrounding anatomic boundaries, and cortical destruction.