Chronic sphenoid sinusitis revisited: comparison of multidetector axial sections, multiplanar reconstructions, and virtual sinoscopy with endoscopic sinus surgery

[Virtual endoscopy of the nose and paranasal sinuses in real-time. Surgical planning system "Sinus endoscopy" (SPS-SE)]

PROBLEM

The aim of this study was the development and clinical evaluation of a new method for virtual endoscopy of the nose and paranasal sinuses.

MATERIAL AND METHODS

The surgical planning system "sinus endoscopy" (SPS-SE) was completely newly developed. The surfaces of the CT images are represented with direct volume rendering (raycasting) which allows a sufficiently high image repetition frequency with the movement of the virtual endoscopy and material effects for a natural appearance were added. Detail accuracy of the virtual illustrations was examined with the help of a picture-statistic comparison between optical and the virtual endoscopy. The evaluation of the system by the patients and physicians was made with a validated questionnaire.

RESULTS

The deviations from defined landmarks of virtual in comparison to optical endoscopy are between 1.4 mm and 11.1 mm. Manoeuvering the virtual endoscope was found to be better than with the optical endoscope but the important parameters for visualization were similar. The accuracy of volume rendering, the high variability of scaling of the anatomical borders and orientation were judged to be negative factors. Altogether there was a balanced opinion from the ENT surgeons but without exception patients judged the system positively.

DISCUSSION

This investigation proved the efficiency of SPS-SE for three-dimensional real time reconstruction of high-resolution CT data of the nose and paranasal sinuses. However, some modifications are necessary before introduction into routine use.