Pulmonary complications in children with hematologic malignancies: accuracy of diagnosis with chest radiography and CT.
OBJECTIVE
To determine the diagnostic accuracy of chest radiography and computed tomography (CT) in patients with complications during treatment for hematologic malignancies.


METHODS
CT scans were obtained 1 week or less before bronchoscopic sampling or biopsy in 48 pediatric patients (age range, 8 months to 18 years at diagnosis) undergoing treatment for leukemia, lymphoma, or myeloproliferative disease. Radiographs were obtained less than 1 week before CT. Pulmonary complications comprised fungal (n = 11), viral (n = 4), and bacterial (n = 5) pneumonias; cryptogenic organizing pneumonia ([COP] n = 4); and pulmonary tumor (n = 4). Chest radiographs and CT scans were rated independently by three radiologists who were unaware of these diagnoses.


RESULTS
Satisfactory diagnostic accuracy, defined by the area under the receiver operating characteristic (ROC) curve, was noted for fungal pneumonia (radiography, ROC area = 0.82; CT, ROC area = 0.78), COP (radiography, ROC area = 0.75; CT, ROC area = 0.75), and pulmonary tumor (radiography, ROC area = 0.73; CT, ROC area = 0.83). Generalizability was good for fungal pneumonia (radiography, generalizability coefficient [GC] = 0.84; CT, GC = 0.84) and COP (radiography, GC = 0.75; CT, GC = 0.99). There was no statistically significant difference in diagnostic accuracy between radiography and CT for any of the diagnoses.


CONCLUSIONS
Radiography and CT have satisfactory accuracies for fungal pneumonia and COP. For these conditions, CT identified more true-positive cases than did radiography.
Winer-Muram
H T
HT
Department of Diagnostic Imaging, St Jude Children's Research Hospital, Memphis, Tenn, USA.
Arheart
K L
KL
Jennings
S G
SG
Rubin
S A
SA
Kauffman
W M
WM
Slobod
K S
KS
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications*; D006470:Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D007223:Infant; D008171:Lung Diseases / Q000000981:diagnostic imaging* / Q000209:etiology; D008172:Lung Diseases, Fungal / Q000000981:diagnostic imaging / Q000209:etiology; D008175:Lung Neoplasms / Q000150:complications / Q000000981:diagnostic imaging; D008297:Male; D009894:Opportunistic Infections / Q000000981:diagnostic imaging; D011014:Pneumonia / Q000000981:diagnostic imaging / Q000209:etiology; D018410:Pneumonia, Bacterial / Q000000981:diagnostic imaging / Q000209:etiology; D011024:Pneumonia, Viral / Q000000981:diagnostic imaging / Q000209:etiology; D012372:ROC Curve; D013902:Radiography, Thoracic; D014057:Tomography, X-Ray Computed