Chest Roentgenogram in the Evaluation of Heart Defects in Asymptomatic Infants and Children With a Cardiac Murmur: Reproducibility and Accuracy

Abstract

ABSTRACT. Objectives. To evaluate the reproducibility and the accuracy of pediatric radiologists' assessments of chest radiographs with respect to the presence or absence of heart defects in children with an asymptomatic heart murmur.Design. Ninety-eight children, ages 1 month to 15 years (median, 30.1 months), referred for evaluation of a heart murmur were consecutively included. They all had a standard chest radiograph and a color Doppler echocardiograph (CDE) performed. Six specialists in pediatric radiology evaluated the chest radiographs independently on two occasions 6 months apart. The radiologists were asked to classify each set of films into one of two categories: heart disease or no heart disease. The outcome of the CDE was considered the definite diagnosis. statistics were used to analyze the reproducibility of the radiologic assessments. Sensitivity, specificity, and the predictive value of a positive and a negative test were used for evaluation of the accuracy of the radiologic assessments.Results. Mean intra-and interobserver values were all <0.6, and the majority were <0.4. Mean sensitivity was 0.3 (range: 0.17-0.52), mean predictive value of a positive test was 0.4, implying that 60% of the positive assessments were falsely positive. Mean specificity was 0.86 (range: 0.75-0.93) and the mean predictive value of a negative test was 0.80 implying that 20% of the negative assessments were falsely negative.Conclusion We found a low reproducibility, as well as a low accuracy, of the radiologic assessments of the chest radiographs of children with an asymptomatic heart murmur with respect to the presence or absence of heart disease. A false-positive radiologic assessment of the chest radiograph with respect to heart defects causes unnecessary anxiety and further examinations, whereas a false-negative assessment might result in omission of relevant investigations and proper identification of the heart defect. We cannot recommend the use of chest radiographs in the initial evaluation of the asymptomatic child with a heart murmur. If a heart defect cannot be excluded by clinical examination a CDE must be performed. Pediatrics 1999;103(2). URL: http://www. pediatrics.org/cgi/content/full/103/2/e15; child, cardiac murmur, chest radiograph, reproducibility, accuracy.ABBREVIATION. CDE, color Doppler echocardiography.

Chest Radiography and the Evaluation of the Neonate for Congenital Heart Disease

“…than for the group as a whole. We found the chest film to have similar sensitivity and specificity for CHD as those found in previous studies in older children [1,11], despite the concern that chest films performed during the first 24-48 hours following delivery may be particularly hmited in their ability to assess for CHD. In fact, wiien patients whose chest films were obtained during this time period were analyzed separately, the results did not differ significantly from those of the entire group.…”

“…Several studies have addressed the utility of the chest film as a screening tool for CHD in older infants and children presenting to pediatric cardiology outpatient clinics [1,9,[11][12][13]. These studies have demonstrated that the chest film does not appear to function as an adequate screening tool, and it does not appear to add significantly to a thorough history and physical examination in determining the hkelihood of CHD.…”

“…In contrast, the chest film remains inexpensive and widely available. Previous studies have addressed the utility of the standard chest film in infants and children, beyond the neonatal period, with suspected heart disease [1,9,[11][12][13]. Several investigators have developed algorithms incorporating radiography into the clinical evaluation of the newborn with suspected CHD [5,6].…”

The Anxiety Level, Awareness and Expectations from Pediatric Cardiologist of Parents Whose Children Have Been Diagnosed with a Cardiac Murmur During the General Physical Examination

“…Semptomu olmaksızın kardiyak üfürümü olan infantlarda yapı-lan bir çalışmada telekardiyografinin kalp hastalığı varlığı veya yokluğunu ortaya koymada düşük doğruluk değeri olduğu gösterilmiştir (14). Yine benzer şekilde 120 infant kalp üfürümü yönünden değerlendirilmiş ve elektrokardiyografinin bu yaş grubunda kalp hastalığını ayırmada yetersiz olduğu vurgulanmıştır (15).…”

Accuracy of chest radiography for evaluating significantly abnormal pulmonary vascularity in children with congenital heart disease

“…Although echocardiography, computed tomography (CT), magnetic resonance imaging (MRI), and cardiac catheterization are currently used as the diagnostic tools of choice in children suspected of having congenital heart disease, chest radiography is still the most common initial study before referring specific investigation. For distinguishing children with congenital heart disease from normal children, the accuracy of chest radiography has been reported from 30 to 78 % in different clinical settings [4,5]. The discrepancy generally depends on the severity of disease, especially the hemodynamic status.…”