Distinguishing Rhinitis and Nasal Neoplasia by Radiography

Abstract

To compare the incidence of radiographic signs in dogs with rhinitis and primary nasal neoplasia and to assess the performance of observers for distinguishing these conditions, the nasal radiographs of 72 dogs with either rhinitis (n = 42) or primary nasal neoplasia (n = 30) were examined by two independent observers using custom-designed forms to record their interpretations. Rhinitis was associated with a higher incidence of focal or multifocal lesions, localised soft tissue opacities, lucent foci, and a lack of frontal sinus involvement. Neoplasia was associated with soft tissue opacities and loss of turbinate detail that affected the entire ipsilateral nasal cavity, signs of invasion of the bones surrounding the nasal cavity, and soft tissue/fluid opacities within the ipsilateral frontal sinus. The signs with the highest positive predictive value (PPV) for rhinitis were absence of frontal sinus lesions and lucent foci in nasal cavity (PPV of each 82%), and invasion of surrounding bones for neoplasia (PPV 88%). There were no significant differences in the position of the lesion within the nasal cavity, incidence of unilateral versus bilateral lesions, calcified lesions, or absence of teeth. There was moderate agreement between observers about the diagnosis (kappa 0.59). Areas (SE) under ROC curves were 0.94 (0.03) and 0.96 (0.03) for observers A and B, respectively (not significantly different; P = 0.68). These results indicate a high accuracy for radiologists examining dogs with nasal diseases. Differentiation of rhinitis and nasal neoplasia should be based on finding combinations of radiologic signs that together have a high PPV. Differences in interpretation between experienced observers in this study suggest that certain signs are potential sources of error.

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“…The level of interobserver agreement in the present study is similar to that found in a previous study assessing the DVIO projection (Russo et al, 2000). The PPVs for neoplasia and rhinitis of the V20R-DCdO view in the present study was very high, similar to what was previously described with the DVIO (Russo et al, 2000).…”

“…The level of interobserver agreement in the present study is similar to that found in a previous study assessing the DVIO projection (Russo et al, 2000). The PPVs for neoplasia and rhinitis of the V20R-DCdO view in the present study was very high, similar to what was previously described with the DVIO (Russo et al, 2000). For neoplasia, each observer had exactly the same radiological diagnostic accuracy as those of CT. For rhinitis, observer B's radiographic diagnosis was similar to that of CT, while observers A and C had lower radiographic sensitivity and NPV than CT, with C (resident) having the lowest performance.…”

“…However biopsy will be required for definitive diagnosis. As previously stated for the DVIO (Russo et al 2000) radiographs alone should not be relied upon for guiding blind nasal biopsy as V20R-DCdO views here agreed only fairly with CT on the affected side and slightly to fairly on location, and interobserver agreement on radiographic lesion location was slight to moderate. Knowing the side of discharge in the patient would potentially have improved radiographic lesion lateralisation.…”

“…Previous studies have shown radiography to have a poor specificity in differentiating inflammatory rhinitis from neoplasia or fungal rhinitis (Tasker et al 1999, Lefebvre et al 2005. However high accuracy and positive predictive value was found when differentiating rhinitis and nasal neoplasia based on the combination of radiographic signs (Russo et al 2000).…”

“…The radiological features of common nasal diseases have been described (Sullivan et al 1986, Sullivan et al 1987, Russo et al 2000. Previous studies have shown radiography to have a poor specificity in differentiating inflammatory rhinitis from neoplasia or fungal rhinitis (Tasker et al 1999, Lefebvre et al 2005.…”