Chest roentgenogram in the evaluation of heart defects in asymptomatic infants and children with a cardiac murmur: Reproducibility and accuracy

Objectives. To evaluate the reproducibility and the accuracy of pediatric r adiologists' 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 month s), referred for evaluation of a heart murmur were consecutively included. They all had a standard chest radiograph and a color Doppler echocardiograp h (CDE) performed. Six specialists in pediatric radiology evaluated the che st radiographs independently on two occasions 6 months apart. The radiologi sts were asked to classify each set of films into one of two categories: he art disease or no heart disease. The outcome of the CDE was considered the definite diagnosis. kappa statistics were used to analyze the reproducibili ty of the radiologic assessments. Sensitivity, specificity, and the predict ive value of a positive and a negative test were used for evaluation of the accuracy of the radiologic assessments. Results. Mean intra- and interobserver kappa values were all <0.6, and the majority were <0.4. Mean sensitivity was 0.3 (range: 0.17-0.52), mean predi ctive value of a positive test was 0.4, implying that 60% of the positive a ssessments 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 th e radiologic assessments of the chest radiographs of children with an asymp tomatic heart murmur with respect to the presence or absence of heart disea se. A false-positive radiologic assessment of the chest radiograph with res pect to heart defects causes unnecessary anxiety and further examinations, whereas a false-negative assessment might result in omission of relevant in vestigations and proper identification of the heart defect. We cannot recom mend the use of chest radiographs in the initial evaluation of the asymptom atic child with a heart murmur. If a heart defect cannot be excluded by cli nical examination a CDE must be performed.