Childhood leukemia: diagnostic accuracy of bedside chest radiography for severe pulmonary complications.
OBJECTIVE
To determine the diagnostic accuracy of bedside chest radiography in patients who develop severe pulmonary complications while undergoing therapy for leukemia.


METHODS
The authors studied 45 patients, aged 21 years and younger, who died of leukemia or of treatment complications and for whom autopsy findings were available. Pulmonary findings at autopsy comprised pneumonia (n = 25), adult respiratory distress syndrome (ARDS) (n = 16), hemorrhage (n = 38), infarction (n = 18), and leukemic cellular infiltration (n = 11). Four radiologists who were unaware of the autopsy diagnoses independently rated antemortem bedside chest radiographs.


RESULTS
Diagnostic accuracy for each disease was as follows: ARDS, 0.81 +/- .03 (standard error); all pneumonias, 0.56 +/- .04; hemorrhage, 0.47 +/- .07; infarction, 0.50 +/- .12; and pulmonary leukemic cellular infiltration, 0.38 +/- .12.


CONCLUSIONS
The specific radiographic appearance of ARDS permits excellent diagnostic accuracy.
Winer-Muram
H T
HT
Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN 38101-0318.
Rubin
S A
SA
Fletcher
B D
BD
Kauffman
W M
WM
Jennings
S G
SG
Arheart
K L
KL
Bozeman
P M
PM
D000208:Acute Disease; D002648:Child; D005260:Female; D006801:Humans; D007951:Leukemia, Myeloid / Q000150:complications* / Q000473:pathology; D017254:Leukemic Infiltration; D008168:Lung / Q000000981:diagnostic imaging* / Q000473:pathology*; D008171:Lung Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications* / Q000473:pathology; D011237:Predictive Value of Tests; D012372:ROC Curve; D013902:Radiography, Thoracic / Q000379:methods