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M9650037.TXT
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1996-03-09
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Document 0037
DOCN M9650037
TI Detection and differential diagnosis of pulmonary infections and tumors
in patients with AIDS: value of chest radiography versus CT.
DT 9605
AU Kang EY; Staples CA; McGuinness G; Primack SL; Muller NL; Department of
Radiology, University of British Columbia,; Vancouver, Canada.
SO AJR Am J Roentgenol. 1996 Jan;166(1):15-9. Unique Identifier : AIDSLINE
MED/96110487
AB OBJECTIVE. The purpose of this study was to compare the sensitivity and
specificity of chest radiography with those of CT in the detection of
pulmonary infections and tumors in patients with AIDS. MATERIALS AND
METHODS. The study was retrospective and included the radiographs and CT
scans of 139 patients. Eighty-nine had one proven thoracic complication,
17 had two proven thoracic complications, and 33 had no active
intrathoracic disease at the time of the examinations. The radiographs
and CT scans were interpreted blindly by two independent observers from
different institutions. The observers assessed for the presence or
absence of intrathoracic disease and recorded the most likely diagnosis
and the degree of confidence in that diagnosis. RESULTS. The patients
were more commonly correctly identified as having or not having
intrathoracic disease on the basis of CT findings than on the basis of
radiographic findings ( p < .01, chi-square test). Of the 106 patients
with intrathoracic complications, 90% (191 of 212 interpretations) were
correctly identified by the two observers on the radiograph and 96% (204
of 212 interpretations) at CT. Of 33 patients without intrathoracic
disease, 73% (48 of 66 interpretations) were correctly identified at
radiography and 86% (57 of 66 interpretations) at CT. Of 89 patients
with one proved thoracic complication, the observers confident in their
first-choice diagnosis in 34% of the cases (61 of 178 interpretations)
at chest radiography and in 47% (83 of 178 interpretations) at CT. This
diagnosis was correct in 67% (41 of 61) of confident radiographic
interpretations as compared with 87% (72 of 83) of interpretations at CT
(p < .01, chi-square test). CONCLUSION. CT is superior to chest
radiography in allowing identification of patients with and without
thoracic disease and in the differential diagnosis of pulmonary
complications of patients with AIDS. However, the improvement in
differential diagnosis is modest. Because in most cases the radiographs
and CT scans were obtained as part of the clinical evaluation, the study
is probably biased toward problematic clinical cases. In the majority of
patients, the chest radiograph provides adequate information and CT is
not warranted.
DE Acquired Immunodeficiency Syndrome/*COMPLICATIONS AIDS-Related
Opportunistic Infections/*RADIOGRAPHY Diagnosis, Differential Human
Lung Diseases/COMPLICATIONS/*RADIOGRAPHY Lung
Neoplasms/COMPLICATIONS/*RADIOGRAPHY
Pneumonia/COMPLICATIONS/RADIOGRAPHY Retrospective Studies Sarcoma,
Kaposi's/ETIOLOGY/RADIOGRAPHY Sensitivity and Specificity *Thoracic
Radiography *Tomography, X-Ray Computed Tuberculosis,
Pulmonary/COMPLICATIONS/RADIOGRAPHY JOURNAL ARTICLE
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).