Diagnostic accuracy of paranasal sinus measurements on multislice computed tomography for sex estimation: A systematic review, meta‐analysis, and meta‐regression

Abstract

This systematic review aimed to answer the question, "Are paranasal measurements obtained with multislice computed tomography able to accurately estimate sex?" This PROSPERO-registered systematic review included six databases and gray literature.Meta-analysis of linear and volumetric data was performed using a random-effects model, mean differences (MDs), and inverse variance. The QUADAS-2 tool-related risk of bias (RoB) and certainty evidence (GRADE approach) were assessed. A total of 1651 articles were initially selected from the main electronic databases for title and abstract screening. After removing duplicates and studies that did not meet the inclusion criteria, 18 studies were eligible for the meta-analysis. The screened studies included 2507 computed tomography of non-pathologic paranasal sinuses of adults aged between 18 and 40 years. Frontal sinus (FS) width (−4.89 mm; p < 0.00001) and maxillary sinus (MS) height (−3.73 mm; p < 0.00001) showed the greatest MD between females and males. Regarding volume, the MD was significant (p < 0.00001) in both paranasal sinuses (−3.01 and −1.04 cm 3 , respectively). The best sensitivity (ability to identify males) and specificity (ability to identify females) were found for the anteroposterior (72.3%) and intermaxillary (69%) MS distances, respectively. In general, all studies exhibited low RoB and applicability concerns. The certainty of the evidence was categorized as very low to moderate. Both paranasal sinuses were shown to be dimorphic structures, which could be valuable tools for forensic identification using the FS width and MS anteroposterior distance measurements. However, heterogeneity among studies must be considered.

Sex Estimation From the Paranasal Sinus Volumes Using Semiautomatic Segmentation, Discriminant Analyses, and Machine Learning Algorithms

“…Because of the unique structures of the paranasal sinuses, forensic identification has demonstrated its effectiveness, particularly in determining sex. 2 Paranasal sinuses are complex anatomical structures that exhibit a highly variable shape, morphology, and size. 1 It has been stated that comprehending the structural variations of the paranasal sinuses and the potential implications of their varying sizes are crucial for surgeons and radiologists to understand sinus pathology and devise the most effective treatment.…”

“…1 Moreover, linear and volumetric measurements of the frontal and maxillary sinuses, because of their unique structure, have the potential to be utilized in forensic identification, particularly in determining an individual's sex. 2 Comparing antemortem and postmortem paranasal sinus radiographs and computed tomography (CT) scans of potential matches and human remains can aid in identification when methods such as fingerprints and DNA analysis are not viable because of issues such as decomposition, deterioration, or burning 3 and when dental comparison is also not applicable because antemortem records are not available. 4 It has been reported that the anatomical features of the sinuses, particularly the frontal sinuses, which exhibit diverse morphological characteristics in each individual, can be used as a form of identification, similar to fingerprints.…”

“…6 Previous studies using paranasal sinus CT measurements have shown high rates of sexual dimorphism, which has been acknowledged as a reliable and promising approach for determining sex in humans. 2 The literature on evaluating the frontal, maxillary, and sphenoidal sinus volumes are limited, despite previous studies showing that these structures are useful for forensic identification and exhibit sexual dimorphism. Only one article has combined these three volumetric data with a discriminant function analysis.…”

“…Since then, numerous studies have been conducted on the use of the paranasal sinuses for identification. Because of the unique structures of the paranasal sinuses, forensic identification has demonstrated its effectiveness, particularly in determining sex 2 …”

“…It has been stated that comprehending the structural variations of the paranasal sinuses and the potential implications of their varying sizes are crucial for surgeons and radiologists to understand sinus pathology and devise the most effective treatment 1 . Moreover, linear and volumetric measurements of the frontal and maxillary sinuses, because of their unique structure, have the potential to be utilized in forensic identification, particularly in determining an individual's sex 2 …”