       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).

