Diagnosis of IPA in HIV: the role of the chest X-ray and radiologist.
The role of clinical information and chest film for the discrimination between invasive pulmonary aspergillosis (IPA) and its differential diagnoses in human immunodeficiency virus (HIV) infection was studied. The diagnostic performance of clinical information and chest film alone and in combination was studied for eight internists and eight radiologists with regular exposure to IPA patients. The multicenter case sample consisted of 25 patients with proven IPA and 25 with other pulmonary diseases typical for HIV. The cases were presented on a CD-ROM. Receiver operating characteristics (ROC) methodology was employed. With clinical information alone, internists achieved the highest diagnostic performance (area under curve/AUC=0.84). Viewing the chest films did not contribute to their performance (AUC=0.80, P=0.26). The radiologist's performance on the basis of viewing the chest film (AUC=0.75) increased significantly ( P=0.012) when clinical information (AUC=0.83) was supplied. IPA cases with characteristic radiological appearance were correctly identified in 90% with chest film. For radiologists with regular exposure to HIV patients, chest films hold relevant information and contribute to the determination in cases with characteristic radiological appearance. Overall and especially in cases with less characteristic radiological appearance, they have significant profit from full access to the clinical data. For internists with regular exposure to HIV patients, chest films do not provide information essential for the verification or differentiation of potential IPA.
Zaspel
Uta
U
Institut für Radiologie, Charité-Universitätsmedizin Berlin, Campus Mitte, Schuhmannstr. 20/21, 10117 Berlin, Germany. uta.zaspel@charite.de
Denning
David W
DW
Lemke
Arne J
AJ
Greene
Reginald
R
Schürmann
Dirk
D
Maschmeyer
Georg
G
Ruhnke
Markus
M
Herbrecht
Raoul
R
Ribaud
Patricia
P
Lortholary
Olivier
O
Zonderland
Harmien
H
Rabe
Klaus F
KF
Röttgen
Rainer
R
Bittner
Roland
R
Neumann
Klaus
K
Oestmann
Joerg W
JW
D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000175:diagnosis; D001228:Aspergillosis / Q000150:complications / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005189:False Positive Reactions; D005858:Germany; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging*; D008172:Lung Diseases, Fungal / Q000150:complications / Q000175:diagnosis*; D010819:Physician's Role; D012372:ROC Curve; D011859:Radiography; D011871:Radiology / Q000379:methods*; D015203:Reproducibility of Results; D006113:United Kingdom