The accuracy of chest radiographs in the detection of congenital heart disease and in the diagnosis of specific congenital cardiac lesions.
BACKGROUND
Congenital heart disease (CHD) is a significant cause of morbidity and mortality in pediatric patients. Traditional teaching holds that specific types of CHD can be diagnosed on the chest radiograph (CXR) through pattern recognition.


OBJECTIVE
To determine the accuracy of radiologists in detecting CHD on the CXR.


METHODS
This study was a blinded retrospective review of chest radiographs from 281 patients (<12 years) by five pediatric radiologists from three institutions. Thirteen groups were evaluated that included 12 categories of CHD and a control group of patients without heart disease. Radiographs were assessed for heart size, heart and mediastinal shape and vascularity. Clinical information, angiography, echocardiograms and surgery were used as the gold standard for definitive diagnosis.


RESULTS
The average accuracy of the five readers in distinguishing normal from CHD patients was 78% (range of 72% to 82%). The overall measure of accuracy in distinguishing specific congenital cardiac lesions among 13 groups of patients was 71% (range of 63% to 79%).


CONCLUSIONS
CXR alone is not diagnostic of specific cardiac lesions, with a low accuracy of only 71%. We believe that less emphasis should be placed on the use of radiographs alone in diagnosing specific congenital cardiac lesions.
Department of Radiology, St. Luke's Medical Center, Quezon, Philippines.
Bernard F
BF
Laya
Marilyn J
MJ
Goske
Stuart
S
Morrison
Janet R
JR
Reid
Leonard
L
Swischuck
Elizabeth H
EH
Ey
Daniel J
DJ
Murphy
Michael
M
Lieber
Nancy
N
Obuchowski
D002648:Child; D002675:Child, Preschool; D017023:Coronary Angiography; D003937:Diagnosis, Differential; D004452:Echocardiography; D005260:Female; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012372:ROC Curve; D012189:Retrospective Studies